Social Services Coordinator - Avamere Rehab of Hillsboro

Responsibilities

• Identifies residents’ emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date
• Works with the Social Services Director and interdisciplinary team to identify discharge plans, barriers, and needs to effectively coordinate a safe discharge from the facility
• Communicates with residents, families, community providers and programs, and any other parties, on a consistent and timely basis
• Acts as the resident advocate by ensuring that their resident rights are upheld and that all parties are acting in the best interest of the resident
• Captures and coordinates with community support services such as home health, hospice, and durable medical services to ensure that residents have the supports and services they need post-discharge
• Arranges for provision of ancillary services for residents while they are in the facility including transportation to/from ancillary appointments
• Coordinates and conducts regular care conferences with residents and families as well as other meetings as needed
• Makes sure to monitor residents’ mood and behaviors, creates behavioral care plans as appropriate, and assists residents in seeking mental health supports and services if needed
• Collaborates with insurance companies and other payors to ensure payment for skilled nursing and/or long-term care services and issues non-coverage notices on behalf of Medicare and insurance companies
• Aids residents and families in applying for Medicaid services, including spend downs
• Aids residents and families in finding appropriate placement in outside facilities following discharge from Avamere facilities
• Acts as the point person and record keeper for grievance and lost items
• Assists residents in obtaining clothing and other personal items as needed
• Participates in facility quality assurance program and other meetings as required
• Performs other duties as assigned

Qualifications

• Prefer bachelor’s degree in public health administration, social work or a related field
• Experience working with electronic medical records and computer documentation systems
• 1 year of experience in a skilled nursing facility or similar health care setting
• Knowledgeable of the rules, regulations and guidelines that govern nursing care facilities
• Understanding of Medicare, Medicaid, and private insurances
• Must be able to read, write, speak, understand, and communicate in English fluently
• Must have an active CPR/BLS certification
• Maintain confidentiality of all resident care information in accordance with HIPAA guidelines