Social Worker I | LeBonheur | Emergency Department | Evenings

About the Role

The Social Worker (MSW) is responsible for supporting safe, timely, and effective patient transitions throughout the acute care episode. This role focuses on psychosocial assessment, discharge planning, resource coordination, and patient/family support. The Social Worker collaborates with the interdisciplinary team to reduce barriers to care, prevent avoidable readmissions, and promote optimal patient outcomes. This position does not perform clinical therapy, diagnosis, or licensed clinical interventions. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What You Will Do

• Discharge Planning & Care Coordination
  • Conducts psychosocial assessments to identify barriers to discharge, including social, financial, environmental, and support needs.
  • Develops individualized discharge plans in collaboration with RN Case Managers, physicians, nursing, therapy, and other team members.
  • Coordinates post-acute services such as home health, DME, transportation, community resources, and follow-up appointments.
  • Ensures timely communication with families, caregivers, and external providers.
  • Facilitates safe transitions to SNF, IRF, LTACH, or home settings.
• Patient & Family Support
  • Provides education on available resources, benefits, and community programs.
  • Assists patients and families with advance care planning discussions (non-clinical guidance only).
  • Supports patients experiencing psychosocial stressors related to hospitalization, illness, or caregiving needs.
  • Advocates for patient rights, preferences, and culturally appropriate care.
• Resource Navigation & Community Coordination
  • Identifies financial, housing, transportation, and social support needs.
  • Connects patients to community agencies, social service programs, and charitable resources.
  • Coordinates with insurance case managers as needed for authorizations and benefits clarification.
  • Assists with applications for Medicaid, disability, or other assistance programs (as allowed by hospital policy).
• Interdisciplinary Collaboration
  • Participates in daily rounds, huddles, and care coordination meetings.
  • Communicates patient needs, barriers, and discharge readiness to the care team.
  • Works closely with RN Case Managers on complex cases requiring both clinical and psychosocial oversight.
• Documentation & Compliance
  • Completes timely and accurate documentation in the electronic medical record.
  • Adheres to CMS, Joint Commission, and hospital policies related to discharge planning and patient rights.
  • Supports hospital initiatives such as readmission reduction, length-of-stay management, and value-based care models (e.g., TEAM Model).
• Additional duties as required

Education

• Master's Degree in Social Work (Required)

Experience

• Experience in acute care, healthcare, social services or community resource coordination preferred.
• Knowledge of discharge planning, community resources, and healthcare systems strongly preferred.

Licenses and Certifications

• Licensed Master Social Worker - Tennessee Board of Social Workers (Required, or licensed within 12 months)
• Licensed Master Social Worker - Mississippi Board of Examiners for Social Workers (Preferred)

Knowledge, Skills, and Abilities

• Excellent interpersonal skills, with the ability to work collaboratively and cooperatively within an integrated interdisciplinary team.
• Comprehensive knowledge of community resources and the ability to effectively link patients and families to appropriate services.
• Ability to gather, synthesize, and summarize relevant data to support sound judgment and patient-centered clinical decision-making.
• Strong oral and written communication skills, enabling effective, professional interaction with hospital staff, agency partners, health care professionals, patients, and families.
• Ability to build constructive, therapeutic relationships with patients and families and to professionally manage difficult, sensitive, or complex social situations.
• Organizational skills to manage multiple tasks, caseloads, and projects while maintaining accuracy and workflow control.
• Ability to use initiative and exercise independent judgment, with well developed critical thinking and problem-solving skills.
• Demonstrated ability to develop and maintain effective working relationships with physicians and collaborate with health care professionals at all levels to achieve shared goals.
• Strong facilitation skills for patient/family meetings, team discussions, and care planning conferences.
• Proficiency with basic computer applications, including Word, internet navigation, and electronic medical record systems.