Social Services Coordinator

Social Services Coordinator

Status: Full-Time,

Day Shift, Monday - Friday 

Location:  Avamere Rehabilitation of Clackamas, 220 E Hereford St, Gladstone, OR 97027

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Job Summary

The Social Services Coordinator works under the supervision of the Social Services Director and in accordance with current federal, state, and local standards, guidelines, and regulations, as well as Avamere's established policies and procedures, to ensure that the medically related emotional, mental, and psychosocial needs of the residents are met. Additionally, the Social Services Coordinator acts as a liaison between the resident/family and community partners, providers, and payors to ensure safe discharge planning and continuation of care.

Essential Duties and Job Responsibilities

• Identifies residents' emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date
• Works with the Social Services Director and interdisciplinary team to identify discharge plans, barriers, and needs to effectively coordinate a safe discharge from the facility
• Communicates with residents, families, community providers and programs, and any other parties, on a consistent and timely basis
• Acts as the resident advocate by ensuring that their resident rights are upheld and that all parties are acting in the best interest of the resident
• Coordinates with community support services such as home health, hospice, and durable medical services to ensure that residents have the supports and services they need post-discharge
• Arranges for provision of ancillary services for residents while they are in the facility including transportation to/from ancillary appointments
• Coordinates and conducts regular care conferences with residents and families as well as other meetings as needed
• Monitors residents' mood and behaviors, creates behavioral care plans as appropriate, and assists residents in seeking mental health supports and services if needed
• Works with insurance companies and other payors to ensure