Social Worker MSW

About the role

At RWJBarnabas Health, our Social Work Case Managers play a vital role in providing comprehensive psychosocial assessments, clinical interventions, discharge planning, and care coordination across the healthcare continuum. Working alongside physicians, nurses, and multidisciplinary teams, our Social Work Case Managers help identify barriers to safe discharge, address healthcare-related social needs, coordinate post-acute services, and support patients and families through some of life's most challenging moments.

Responsibilities

• Conducting comprehensive psychosocial assessments and documenting patient needs, risks, strengths, and discharge considerations in the electronic health record.
• Developing and implementing individualized clinical interventions to support safe discharge, reduce readmissions, and promote continuity of care.
• Participating in interdisciplinary rounds, presenting cases, communicating discharge planning updates, and collaborating with physicians, nurses, and other members of the care team.
• Assessing healthcare-related social needs and Social Determinants of Health (SDOH) to identify barriers to care and coordinate appropriate community and healthcare resources.
• Coordinating referrals for post-acute services, including durable medical equipment, home care, skilled nursing facilities, rehabilitation, and other community-based resources.
• Identifying and addressing barriers to patient flow and discharge while supporting length-of-stay goals and escalating complex issues to appropriate leaders.
• Collaborating with Utilization Review and other departments to support insurance authorization, clinical documentation, medical necessity, and appropriate level-of-care determinations.
• Providing evidence-based clinical social work interventions, including supportive counseling, crisis intervention, and psychotherapeutic approaches to address psychosocial distress related to illness, grief and loss, trauma, life transitions, and other major events.
• Conducting specialized psychosocial assessments and providing clinical support for patients experiencing complex medical conditions, including transplant, oncology, hemodialysis, perinatal, survivorship, and end-of-life concerns.
• Maintaining timely, accurate, and compliant clinical documentation while adhering to CMS Conditions of Participation, HIPAA, patient rights, and organizational policies.
• Participating in quality improvement, professional development, and department initiatives focused on length-of-stay reduction, patient flow, performance, engagement, and continuity of care.
• Supporting patients and families with empathy, cultural sensitivity, professionalism, and clear communication during difficult conversations and complex care transitions.

Requirements

• Master of Social Work (MSW) degree.
• Current New Jersey state licensure as a Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW), as required by the NJ State Board of Social Work Examiners.
• EARC certification obtained within six (6) months of hire; certification will be arranged by RWJBarnabas Health.
• Two (2) or more years of post-licensure experience within the healthcare field, including experience in acute care, home health, post-acute services, or related healthcare settings.

Qualifications

• Working knowledge of comprehensive psychosocial assessment, discharge planning, transitions of care, interdisciplinary collaboration, and healthcare-related social needs.
• Knowledge of utilization management principles, level-of-care criteria, healthcare reimbursement, and payment models, including Medicare, managed care, value-based arrangements, and other healthcare financing structures.
• The ability to effectively identify and address discharge barriers, coordinate services across acute, post-acute, and community settings, and manage multiple priorities in a fast-paced environment.
• The ability to provide evidence-based clinical social work interventions, including supportive counseling, crisis intervention, and psychotherapeutic approaches.
• Strong knowledge of applicable regulatory and legal requirements, including CMS Conditions of Participation, HIPAA, Medicare Beneficiary Notices, patient rights, and organizational policies.
• Strong communication, collaboration, critical-thinking, and documentation skills, with the ability to engage diverse patient populations with cultural sensitivity and respect.
• Certification in case management, such as ACM or CCM, is preferred.

Benefits

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

RWJBarnabas Health is an Equal Opportunity Employer