Community Transition Social Worker at SilverStay

Baltimore, Maryland, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Mar, 26

Salary

65000.0

Posted On

13 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Social Work, Discharge Planning, Long-Term Care, Communication, Medicaid Waivers, Geriatric Resources, Caseload Management, Community Engagement, Reporting, Liaison Work, Google Sheets, Microsoft Excel, Email Communications, Travel, Patient Transition, Funding

Industry

Hospitals and Health Care

Description

Community Transition Social Worker At SilverStay, we’re on a mission to be the leading healthcare services company nationwide for complex discharges by 2030. We help hospitals, families, and post-acute providers work together to ensure even the most challenging patient discharges happen smoothly, quickly, and compassionately. We are seeking a proactive and highly organized Community Transition Social Worker to manage a caseload of approximately 50-60 patients currently residing in Assisted Living Facilities (ALFs) under hospital-funded contracts. The primary objective of this role is to successfully transition financial responsibility from the hospital to sustainable, safe and appropriate care settings. This is a hybrid role requiring onsite visits to facilities to liaise with community partners and facility administration. Key Responsibilities: Contract Conversion & Funding: Execute the strategic transition of patients from temporary hospital contracts to permanent payer sources, specifically navigating Medicaid waiver, LTC (Long Term Care) transitions and addressing citizenship/eligibility complexities. Caseload Management: Maintain meticulous oversight of a shared caseload of 50+, ensuring critical deadlines are met to prevent funding gaps or contract overstays. Community engagement: Traveling to meet patients, families, guardians and/or ALF providers to ensure engagement and collaboration for transition needs. 90% of travel within the Baltimore area, expanding to surrounding counties in Maryland. Reporting: Generate detailed Monthly Summaries regarding patient status, waiver application progress, and barriers to contract resolution. Liaison Work: Act as the primary bridge between the hospital and ALF providers to ensure continuity of care while finalizing permanent placement arrangements. Qualifications: Background: Professional experience in Social Work, discharge planning, or Long-Term Care (LTC) settings. Communication: Licensure: Active Social Work license required. Active Driver’s License also required. Skills: Strong knowledge of the aging population, geriatric resources, and complex payer systems (Medicaid Waivers). Software: Knowledge of Google Sheets/Microsoft Excel & email communications. Start Date: ASAP. Compensation & Benefits: Salary: $55,000 - $65,000; Commensurate with experience and potential impact. Health & Wellness: Comprehensive medical, dental, and vision coverage - including spouse and family. Retirement Planning: 401(k) with employer contribution. Paid Time Off: Generous PTO plus holidays. Flexible schedule with autonomy to structure your time around outcomes, not shifts. Professional Development: Ongoing training, mentorship, and opportunities to grow into leadership as SilverStay expands. SilverStay is a 2024 Baltimore Business Journal Best Places to Work! Learn more about SilverStay here. SilverStay is a 2024 Baltimore Business Journal Best Places to Work! Learn more about SilverStay here.

Responsibilities

The Community Transition Social Worker will manage a caseload of 50-60 patients, focusing on transitioning financial responsibility from hospitals to appropriate care settings. This includes executing contract conversions, maintaining oversight of caseloads, and engaging with community partners.