Social Worker, Patient​/Health Advocate

Social Worker

Bain Bridge Nursing & Rehabilitation Center
Location: Bronx, NY
Department: Social Services
Reports To: Director of Social Services / Administrator
Employment Type: Full-Time

Bain Bridge Nursing & Rehabilitation Center is seeking a compassionate, organized, and resident-focused Social Worker to join our interdisciplinary care team. The Social Worker will support residents and families throughout the admission, rehabilitation, long-term care, and discharge planning process. This role is responsible for assessing psychosocial needs, advocating for resident rights, coordinating services, supporting care planning, and helping residents achieve the highest possible level of emotional, social, and physical well-being.

The ideal candidate is a strong communicator who is comfortable working in a skilled nursing and rehabilitation environment, collaborating with nursing, therapy, medical, admissions, case management, and administrative teams to provide person-centered care.

Conduct psychosocial assessments for new admissions and ongoing residents to identify emotional, behavioral, social, family, financial, and discharge planning needs.

Participate in interdisciplinary care planning meetings and contribute to individualized care plans that support each resident’s goals, preferences, and rights.

Provide supportive counseling and crisis intervention to residents and families related to adjustment, illness, rehabilitation, long-term care placement, grief, loss, and end-of-life concerns.

Assist residents and families with discharge planning, including coordination of home care, durable medical equipment, community resources, outpatient services, transportation, and follow-up appointments.

Serve as an advocate for residents, ensuring that resident rights, dignity, privacy, choice, and quality of life are respected.

Coordinate and document care conferences, family meetings, grievances, psychosocial interventions, advance directives, and discharge planning activities in accordance with facility policy and regulatory requirements.

Collaborate with nursing, rehabilitation therapy, dietary, activities, medical providers, admissions, business office, and outside agencies to support resident needs.

Assist with referrals to mental health services, hospice, palliative care, substance use support, guardianship resources, Medicaid/community programs, and other appropriate services.

Support residents and families with advance directives, health care proxy information, power of attorney documentation, and related resources as appropriate.

Respond to resident and family concerns in a timely, professional, and compassionate manner.

Maintain accurate, timely, and confidential documentation in the electronic medical record.

Participate in quality assurance, compliance, survey readiness, and facility initiatives related to resident well-being and social services.

Ensure compliance with HIPAA, CMS, New York State Department of Health requirements, resident rights regulations, and facility policies.

Bachelor’s degree in Social Work, Gerontology, Psychology, Sociology, Rehabilitation Counseling, Special Education, or a related human-services field required.

Minimum of one year of supervised social work experience in a health care setting working directly with individuals required.

Master’s degree in Social Work preferred.

LMSW, LCSW, or license-eligible status preferred, where applicable.

Experience in a skilled nursing facility, rehabilitation center, hospital, long-term care setting, or senior services environment strongly preferred.

Knowledge of MDS, care planning, discharge planning, resident rights, and long-term care regulations preferred.

Bilingual English/Spanish a plus.

Excellent interpersonal, communication, and documentation skills.

Strong ability to build trust with residents, families, and interdisciplinary team members.

Ability to manage multiple priorities in a fast-paced health care environment.

Compassionate, patient, and professional approach to resident care.

Strong problem-solving, advocacy, and conflict-resolution skills.

Ability to maintain confidentiality and exercise sound judgment.

Comfortable using electronic medical records and basic computer systems.

Ability to work in a skilled nursing and rehabilitation facility environment.

Ability to sit, stand, walk throughout the facility, and communicate effectively with residents, families, staff, and outside providers.

Must be able to respond appropriately to resident and family needs, including emotionally sensitive situations.

• Competitive salary
• Health, dental, and vision insurance
• Paid time off
• Supportive team environment
• Opportunities for professional growth
• Meaningful work serving residents and families in a person-centered care setting