Care Coord, Social Worker MSW - PD

Location:

Teaneck, NJ, United States
Date Posted:
Aug 27, 2026

Welcome to Holy Name, a medical center where innovation is not just a goal — it's a commitment. Here, medical excellence thrives, allowing hope to reign supreme and leaving no room for fear. At our hospital, every patient is cared for with undivided attention — because healing every soul is our sole focus.

Holy Name is New Jersey's only independent Catholic health system, comprising a 361-bed acute care hospital, a renowned cancer center, a state-of-the-art fitness center, a residential hospice, a prestigious nursing school, and an extensive physician network. Healing at Holy Name goes beyond medicine and technology – it is infused with faith, conviction, compassion, and a commitment to educating the next generation of healthcare professionals through a variety of residency and educational programs.

Our mission to provide care for the body, mind, and soul spans education, prevention, diagnosis, treatment, rehabilitation, and overall wellness. This is at the core of who we are and what we do, and we've done it this way across generations, every single day, for nearly 100 years. Every innovation, medical breakthrough, and groundbreaking treatment is powered by some of the best minds in medicine, ensuring nothing is left on the table or the road to recovery.

The Social Worker/Care Coordinator is responsible for facilitating and coordinating services for patients through the continuum of care that ensures quality care in the most cost efficient manner on assigned units or teams. Assist patients and their families in understanding illness and disabilities. They help resolve personal, financial, and environmental difficulties which interfere with obtaining maximum benefits from care. Makes appropriate referrals and arrangements to help patients/families achieve a safe discharge plan of care.

Assist in coverage of specialty areas, such as Labor and Delivery, Pediatrics, Intensive Care Unit, Clinic and Emergency Department. Assignments vary based on departmental need and coverage.

• Performs timely new admission screening and interviews with patients and families to assess and evaluate patient's social, psychological and environmental situations. Reviews patient information obtained from physician, staff and medical records to determine patient's needs
• Provides social work services in accordance with the assessment and diagnosis. Conducts individual/group treatment and information sessions for patients and families with personal and environmental difficulties which may interfere with obtaining maximum benefits from medical/psychiatric care
• Directs patients and families to appropriate community agencies and resources for financial assistance, counseling, rehabilitation, auxiliary care and long term care via written and oral communication
• Conducts complex discharge planning for patients with serious disabilities or illnesses, assessing needs for more specialized care and arranges placement in other health care facilities, rehabilitations or extended care facilities as needed.
  
  Including but not limited to obtaining and processing all necessary information to submit EARC-PAS to above mentioned facilities
• Arranges ambulance transportation as needed for patients prior to discharge or transfer to another facility
• Participates as an active, informative and cooperative team member of the health care staff by attending discharge rounds for case finding/follow up and participating in the discharge plan while acting as an advocate for the patient. Arranges family meetings to assist in discharge planning as indicated
• Legibly documents social work assessment and interventions in a timely manner in patient's medical records according to department policy
• Attends daily discharge rounds and weekly interdisciplinary rounds on respective units
• Contributes any new found resources and knowledge with fellow social workers
• Assist in Quality Improvement projects specific to the department
• Maintains and manages Transfer database requirements for statistical analysis of data
• Maintains a knowledge of resources available in the community for patients and their families
• Contacts proper agency for suspected child abuse, elder abuse and domestic violence referrals
• Arranges hemodialysis for new and existing hemodialysis patients
• Provide copy IM letter to patients with 48 hours of discharge
• Refers patients to financial counselors if indicated
• Accepts and completes additional…