Overview

JOB DESCRIPTION – POSITION REQUIREMENTS

JOB TITLE: Social Worker

CC/Department: 6580/Skilled Nursing Facility

Reports to: Director of Skilled Nursing Facility

JOB SUMMARY:

The Social Worker provides psychosocial support to residents in attaining or maintaining their highest practicable well-being. This position plays a key role in patient assessment, care planning, coordination of services and when applicable discharge planning. The social worker collaborates closely with the interdisciplinary team, family, and community partners to ensure ethical, and patient-centered care in compliance with federal, state, and facility regulations.

Responsibilities

Main Responsibilities:

Resident Assessment & Care Planning:

Complete social service assessments and contribute to individualized care plans, ensuring goals support each resident’s emotional, mental, and psychosocial needs. Encourage residents and families to participate in care planning meetings.

Admissions & Discharge Support:

Assist with preadmission evaluations and required screenings. Coordinate safe and effective discharge planning, including arranging community services, follow-up care, and access to financial, legal, and social resources.

Resident Advocacy & Support:

Identify and communicate residents’ social, emotional, and psychological needs to the care team. Advocate for residents’ rights and dignity, assist with grievances, and ensure access to appropriate mental health and psychosocial resources. Ensure

Documentation & Compliance:

Maintain timely, accurate, complete, and professional documentation. Ensure compliance with federal and state regulations, facility policies, HIPAA, Title 22, CMS conditions of participation and social work ethical standards.

Advance Care Planning:

Support residents and representatives in understanding and completing Advance Directives.  Ensure staff are aware of residents’ code status and end-of-life preferences.

Safety, Confidentiality & Reporting:

Protect resident privacy, follow infection control and safety procedures, and report incidents such as abuse, neglect, policy violations, or workplace injuries according to facility guidelines.

Resident Engagement & Daily Support:

Obtain social histories, assist residents with personal needs (e.g., supplies, clothing, transportation), support communication needs, and act as a resource for behavioral interventions.

Interdepartmental Collaboration:

Coordinate Social Services activities with other departments and participate in care plan meetings, psychotropic reviews, and required facility meetings. Provides education and support to staff regarding psychosocial issues, trauma-informed care, and patient rights. Supports the facilities Quality Assurance and Performance Improvement (QAPI) initiatives by participating in audits and data collection as needed.

Professional Development & Leadership:

Complete all required training and continuing education. Assist with policy development and assume leadership of the Social Services Department in the Director’s absence.

Qualifications

QUALIFICATIONS/JOB REQUIREMENTS:

EDUCATION:

Bachelor’s degree in social work, or another human service field to include but not limited to sociology, gerontology, counseling or psychology.

One year of supervised social work experience in a healthcare setting working directly with individuals.

Skills / Knowledge / Experience:

Minimum 1 year of experience in social services and discharge planning.Strong knowledge of CMS Conditions of Participation, CDPH standards, and Title 22 requirements.

Proficient in Google Docs. Experience in working with an EMR/PCC system preferred.Excellent verbal, written, and interpersonal communication skills; ability to exercise sound judgment.

Ability to read, write, speak, and understand English

Demonstrated leadership, organization, teamwork, and problem-solving abilities.Ability to work effectively in a multidisciplinary, fast-paced environment and maintain composure under stress.

Ability to make independent decisions and interact tactfully with residents, families, staff, and regulatory personnel.

Capable of coordinating meetings, setting goals, and managing tasks efficiently.Physically able to bend, stoop, kneel, crouch, perform overhead lifting, move intermittently throughout the workday, and assist with resident evacuation if needed.

Willingness to work beyond normal hours, including weekends and holidays as requested.

Compliance as a Condition of Employment and Performance Appraisal

Agreement to abide by all standards, policies, and procedures of the facility, including the facility’s compliance and ethics program, is a condition of employment. Compliance will be a factor in evaluating job performance. Violations, including failure to report violations, will result in disciplinary action, up to and including termination.

This job description is intended to convey the general scope of the major duties and responsibilities inherent in this position. Other tasks not listed here may be assigned by the Administrator. Periodic revision may be necessary to reflect changes in expectations placed on long-term care by various governmental agencies. This job description will be reviewed and/or revised annually and as needed.