Social Worker, Crisis Counselor

Hilltop Center - WV, a skilled nursing and rehabilitation facility in Fairmont, seeks a compassionate Social Worker to support residents and families throughout their care journey. This role conducts psychosocial assessments, develops care plans, coordinates discharge and community resources, and provides counseling, crisis intervention, and grief support. The Social Worker collaborates closely with nursing, therapy, and medical teams, advocates for resident rights and quality of life, leads care conferences, and maintains accurate, regulatory-compliant documentation while fostering strong family and community relationships.

Responsibilities

• Provide psychosocial assessments and care planning for residents and families
• Coordinate discharge planning and community resource referrals
• Lead care conferences and support interdisciplinary team communication
• Offer counseling, crisis intervention, and grief support
• Advocate for resident rights, dignity, and quality of life
• Document assessments, interventions, and outcomes in compliance with regulations
• Educate residents and families on services, benefits, and care options
• Support admission, transition, and adjustment to long-term care
• Collaborate with nursing, rehab, and medical staff to address social needs
• Participate in quality improvement and regulatory compliance activities

Required Skills

• Psychosocial assessment
• Discharge planning
• Care planning and documentation
• Counseling and crisis intervention
• Case management
• Knowledge of community resources
• Interdisciplinary teamwork
• Regulatory and compliance knowledge (long-term care)
• Electronic health record (EHR) documentation
• Family engagement and conflict resolution