Social Worker I – In Home Hospice

Methodist Le Bonheur Healthcare

. Conduct psychosocial assessments to identify discharge barriers .

Posted 11/12/2026full-timeGermantown • Tennessee • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in psychosocial assessments, discharge planning, and community resource coordination, while effectively advocating for patient rights and preferences. Proficient in collaborating with interdisciplinary teams and managing complex social situations to support patient transitions and care continuity.

Highest-signal resume keywords

Master's Degree Social WorkLicensed Master Social Worker TennesseeDischarge Planning KnowledgeCommunity Resource CoordinationInterdisciplinary Team Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Psychosocial AssessmentDischarge PlanningData SynthesisElectronic Medical Record DocumentationCommunity Resource Knowledge

Soft Skills

Interpersonal CommunicationOrganizational SkillsCritical ThinkingProblem-SolvingFacilitation Skills

Tools & Technologies

Word ProcessingInternet NavigationElectronic Medical Record Systems

Certifications & Qualifications

Licensed Master Social Worker TennesseeLicensed Master Social Worker Mississippi (Preferred)

Industry Keywords

Acute CareHealthcare SystemsSocial ServicesPatient AdvocacyValue-Based Care Initiatives

Tech Stack

Tools & technologies

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About the role

Key responsibilities & impact

Conduct psychosocial assessments to identify discharge barriers
Develop individualized discharge plans with RN Case Managers, physicians, nursing, therapy, and other team members
Coordinate post-acute services including home health, DME, transportation, community resources, and follow-up appointments
Communicate with families, caregivers, and external providers
Facilitate safe transitions to SNF, IRF, LTACH, or home settings
Educate patients and families about resources, benefits, and community programs
Assist with non-clinical advance care planning guidance
Support patients experiencing psychosocial stressors related to hospitalization, illness, or caregiving
Advocate for patient rights, preferences, and culturally appropriate care
Identify financial, housing, transportation, and social support needs
Connect patients with community agencies, social service programs, and charitable resources
Coordinate with insurance case managers for authorizations and benefits clarification
Assist with Medicaid, disability, and other assistance program applications as permitted
Participate in daily rounds, huddles, and care coordination meetings
Communicate patient needs, barriers, and discharge readiness to the care team
Complete timely and accurate electronic medical record documentation
Adhere to CMS, Joint Commission, and hospital discharge planning and patient rights policies
Support readmission reduction, length-of-stay management, and value-based care initiatives
Does not provide psychotherapy, diagnose mental health conditions, conduct clinical risk assessments requiring licensure, or perform licensed clinical interventions

Requirements

What you’ll need

Master's Degree Social Work
Licensed Master Social Worker Tennessee required, or licensed within 12 months
Experience in acute care, healthcare, social services or community resource coordination preferred
Knowledge of discharge planning, community resources, and healthcare systems strongly preferred
Excellent interpersonal, oral, and written communication skills
Ability to collaborate within an interdisciplinary team
Comprehensive knowledge of community resources
Ability to gather, synthesize, and summarize relevant data
Ability to manage difficult, sensitive, or complex social situations
Organizational, critical thinking, problem-solving, facilitation, and independent judgment skills
Proficiency with Word, internet navigation, and electronic medical record systems
Ability to perform medium work, exerting up to 25 lbs. occasionally and/or 10 lbs. frequently
Good balance and coordination
Ability to react quickly to emergency situations
May be required to take rotating nights/weekends call
Preferred: Licensed Master Social Worker Mississippi

Benefits

Comp & perks

Hybrid work arrangement
Full-time employment
Opportunities for career growth
Mission-driven work supporting patients and families
Participation in family/team-oriented workplace culture