Social Worker, Medical Social Worker

Springbrook Center - ME, a skilled nursing and rehabilitation facility in Skowhegan, seeks a Social Worker to provide resident-centered support across short-term rehab and long-term care. You will complete psychosocial assessments, develop individualized care plans, coordinate discharge planning, and connect residents with community resources. Working in a collaborative, interdisciplinary team, you'll provide counseling to residents and families, support adjustment to facility life, advocate for residents' rights, and maintain accurate documentation to promote quality outcomes and quality of life.

Responsibilities

• Conduct psychosocial assessments for new and existing residents.
• Develop and update individualized care plans in collaboration with the interdisciplinary team.
• Coordinate discharge planning and community resource referrals.
• Provide counseling and support to residents and families during transitions and crises.
• Advocate for residents' rights, preferences, and psychosocial needs.
• Facilitate care conferences and participate in team meetings.
• Maintain accurate, timely documentation in accordance with regulations and facility policies.
• Collaborate with nursing, therapy, and medical staff to support quality outcomes.
• Educate residents and families about services, benefits, and care options.
• Support adjustment to long-term care and rehabilitation environments.

Required Skills

• Clinical social work
• Psychosocial assessment
• Care planning
• Discharge planning
• Crisis intervention
• Case management
• Interdisciplinary collaboration
• Documentation/EMRFamily counseling
• Knowledge of Medicare/Medicaid