Social Worker MSW - Per Diem

RARITAN BAY MEDICAL CENTER- PERTH AMBOY Perth Amboy Requisition # 2021-103242 ShiftDay StatusPer Diem Weekend WorkOne Weekend a Month HolidaysTwo of 6 On CallNo On-Call Required Shift HoursVaried Address530 New Brunswick Avenue, Perth Amboy, 08861

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How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

The Social Worker MSW aims to establish a continuum of care plan that provides for the safe and appropriate transition of the patient from the hospital to the home environment or another health care facility.  Utilizes the social work process in determining individual patient needs and the appropriate community resources available to assure continuity of care.


A Day in the Life of a Social Worker at Hackensack Meridian Health includes: 


  • Screens admissions according to department policy and procedure for identification of “high-risk” patients in need of our requesting social service intervention.
  • Makes daily rounds of assigned units to review patients with Patient Care Coordinator and/or nursing staff to obtain referrals.  Reviews patient locator daily and checks message board at frequent intervals daily.
  • Attends weekly multidisciplinary plan of care meetings on assigned units.
  • Initiates social service intervention within five working days of admission/referral on patients that meet the department’s established “high-risk” criteria.
  • Responsible for the completion of the psychosocial assessment and coordination of a safe and appropriate discharge plan in collaboration with other members of the health care team.
  • Assess and evaluate post hospital needs through interview and assessment of patient and/or family/significant other and formulate a discharge plan that appropriately addresses the physical, social, economic and emotional needs of the patient.  Evaluate needs taking into consideration the patient’s current medical problems, past medical history, gender, family and community support system, living situation, financial resources, mental status, cultural factors, religious beliefs and the special needs of the patient’s age group.  Evaluate appropriateness of plan and makes revisions as necessary based on ongoing reassessment of patient’s needs.
  • Elicits and documents patient’s and/or family’s/significant other’s understanding of, and agreement with the discharge plan.
  • Maintains ongoing communication with the patient, family/significant other, physician, nursing staff, discharge planning nurse, utilization review nurse, and/or other members of the healthcare team concerning the status of the discharge plan.
  • Provides information and support to patient, family or significant other on a ongoing basis and records same in medical record.
  • Investigates insurance coverage as needed for continuum of care needs.  Communicates verbally and in writing with third party payors as appropriate to facilitate the discharge plan.
  • Responsible for assessing the adequacy of patient’s and/or family’s/significant other’s insurance coverage and/or financial resources for post hospital services.  Investigates availability of alternative community resources or payment options when insurance coverage and/or financial resources are inadequate.  Initiates public assistance and entitlement program referrals as appropriate.
  • Implements the agreed upon discharge plan by coordinating referrals to the appropriate community agencies, services, programs, facilities, etc.  Referrals may include Medicare certified home health agencies, proprietary home health agencies, domestic agencies,  pre-admission screening, extended care facilities, rehabilitation facilities, nutrition programs, transportation services, durable medical equipment providers, enternal/parenteral therapies, entitlement programs, mental health/counseling agencies, etc.
  • Reviews referrals/transfer forms for compliance with department policy and home health agency/extended care facility/rehab facility criteria.
  • Assists in the evaluation of services in the community.
  • Maintains ongoing communication with home health agencies, community agencies/programs, extended care facilities, rehab facilities, durable medical equipment companies, etc. and channels feedback appropriately.
  • Reports identified problems to the assistant director and submits written report according to department policy and procedure.
  • Documents all interventions on the Discharge Planning/Social Service Initial Assessment Form and/or the Discharge Planning/Social Work Interdisciplinary Progress Notes in the patient’s medical record according to department policy and procedure.  Documentation includes:
  • Is familiar with and participates in the department’s Quality Assessment and Improvement Plan.
  • Collects/compiles data for quality assessment and improvement indicators as assigned and submits data within specified time frames.
  • Assists in the development of quality assessment and improvement indicators.
  • Prepares and submits monthly report; inclusive of accurate statistical data to the Assistant Director of Discharge Planning within specified department time frames.
  • Completes annual JC and OSHA required programs.
  • Maintains current competency in skills and knowledge of trends and new developments in social work and discharge planning.  Assumes responsibility for ongoing professional development and maintains open avenues of communication toward patients, families, hospital personnel, medical staff, community agencies, home health agencies and other outside agencies/facilities as appropriate.
  • Maintains current knowledge of available agencies, services, programs, extended care facilities, rehab facilities, products, equipment and third reimbursement rules and regulations pertinent to home care through ongoing communication with home health agencies, facilities, community agencies, services and programs, vendors, third party payors, etc.  Investigates new agency/programs/services as necessary.
  • Remains knowledgeable of all applicable JC, State and Federal requirements regarding discharge planning/social work including Medicare and Medicaid rules and regulations.
  • Annually attends meetings, seminars and/or continuing education programs, as assigned, to update knowledge of current developments in discharge planning/social work, including agencies, services, programs and facilities available in the community.  Prepares and submits written summary of program and shares information with staff as per medical center and department policy and procedure.
  • Develops collaborative relationships with staff from frequently used community agencies/services/programs.
  • Regularly attends and participates in department staff meetings.  Reviews and signs off on minutes for any meeting not attended.
  • Maintains current knowledge of social work and keeps abreast of changes in social work trends and practices by attendance at and/or participation in continuing education programs, in-service programs, unit conferences, etc.
  • Serves on committees as assigned.
  • Educates physicians, nursing staff and other members of the health care team regarding the discharge planning process and available community agencies, facilities, services and programs on an ongoing basis through presentation of unit conferences, participation in Nursing Forum and participation in the education of social work interns.
  • Collaborates with the Assistant Director of Social Work on complex cases or disposition problems.
  • Provides competent assessment, treatment and/or care to patients appropriate for the individualized and developmental needs for the ages of those patients served.
  • Demonstrates competency in assessing, analyzing and utilizing data for the purpose of obtaining information necessary for effective decision making and performance improvement processes.
  • Performs other duties as assigned.


Knowledge, Education and Skills Required: 


  • Masters of Social Work degree required.  New Jersey social work license required at an LSW or LCSW level.
  • One year experience in a hospital or health related agency preferred.  Bilingual (English/Spanish) preferred.
  • Normal hospital and office.  May encounter communicable and infectious diseases through the course of patient contact.  Working hours may very dependent on case mix and family needs.  Flexible hours according to assignment and needs of the department.


Knowledge, Education and Skills Preferred: 


  • Bilingual (English/Spanish) preferred


Required Certification/Licensing:

  • New Jersey social work license required at an LSW or LCSW level.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Our Network

Hackensack Meridian Health (HMH) is a Mandatory COVID-19 and Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.