The Social Worker in a Skilled Nursing Facility (SNF) is responsible for supporting residents’ psychosocial well-being by providing counseling, discharge planning, and coordination of services. This role ensures compliance with federal and state regulations while advocating for residents’ rights, dignity, and quality of life.
Conduct psychosocial assessments for residents upon admission and as needed
Develop, implement, and update individualized care plans in collaboration with the interdisciplinary team
Provide counseling and emotional support to residents and their families
Facilitate discharge planning, including coordination with community resources and services
Assist residents and families with adjustment to illness, disability, and long-term care placement
Advocate for residents’ rights and address grievances or concerns
Maintain accurate and timely documentation in compliance with regulatory standards
Coordinate with physicians, nursing staff, therapy teams, and external agencies
Assist with advance directives, guardianship issues, and end-of-life planning
Participate in care plan meetings and quality improvement initiatives
Ensure compliance with CMS, state, and facility policies
Bachelor’s Degree in Social Work (BSW) required; Master’s Degree (MSW) preferred
Current state licensure (e.g., LSW/LCSW) as required
Minimum of 1–2 years of experience in healthcare, preferably in a SNF or long-term care setting
Knowledge of Medicare, Medicaid, and discharge planning processes
Strong interpersonal, communication, and organizational skills
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