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Social Services Coordinator - Avamere Rehab of Hillsboro

Avamere·Hillsboro, Oregon

Full Time·On Site·0-2 yrs·Posted 20 days ago
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About the role

The Social Services Coordinator manages the emotional, mental, and psychosocial needs of residents while ensuring comprehensive care plans are maintained. They act as a liaison between residents, families, and community partners to coordinate safe discharge planning and continuation of care.

Social Services Coordinator

Status: Full-Time (M-F; 8am-4:30pm)

Setting: Skilled Nursing Facility

Location: Avamere Rehab Hillsboro; 650 SE Oak St, Hillsboro, OR 97123

Apply at www.teamavamere.com [http://www.teamavamere.com]

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.

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 payment for skilled nursing and/or long-term care services and issues non-coverage notices on behalf of Medicare and insurance companies
  • Assists residents and families in applying for Medicaid services, including spend downs
  • Assists residents and families in finding appropriate placement in outside facilities following discharge from Avamere facilities
  • Acts as the point person and record keeper for grievance and lost items
  • Assists residents in obtaining clothing and other personal items as needed
  • Participates in facility quality assurance program and other meetings as required
  • Performs other duties as assigned

Qualifications

  • Prefer bachelor’s degree in public health administration, social work or a related field
  • Experience working with electronic medical records and computer documentation systems
  • 1 year of experience in a skilled nursing facility or similar health care setting
  • Knowledgeable of the rules, regulations and guidelines that govern nursing care facilities.
  • Understanding of Medicare, Medicaid, and private insurances.
  • Must be able to read, write, speak, understand, and communicate in English fluently
  • Must have an active CPR/BLS certification
  • Maintain confidentiality of all resident care information in accordance with HIPAA guidelines.

Benefits

  • At Avamere, we believe in taking care of our employees. We offer a comprehensive benefits package that includes:
  • Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible.
  • 401 (k) Plan: After 90 days of employment, with matching program.
  • Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave.
  • EAP Canopy with unlimited telehealth mental health visits.
  • Continuing Education and Higher Education Reimbursement.
  • Generous employee referral bonus program.
  • Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account).
  • Professional Development: Opportunities for growth and development within the company.
  • Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more.

Avamere is an Equal Opportunity Employer and participates in E-Verify

Requirements

Candidates should ideally hold a bachelor's degree in social work or public health and have at least one year of experience in a skilled nursing facility. Required qualifications include CPR/BLS certification and fluency in English.

  • bachelor degree
  • Case Management
  • Care Planning
  • HIPAA Compliance
  • Crisis Intervention
  • Insurance Coordination
  • Electronic Medical Records
  • Interdisciplinary Collaboration
  • Discharge Planning
  • Resident Advocacy
  • Medicaid Application

Posting details

Employment type
Full Time
Work arrangement
On Site
Experience
0-2 yrs
Location
Hillsboro, Oregon
Posted
Jul 7, 2026
Application
Employer website
AV

Hiring organization

Avamere

Avamere was founded in 1995 with a single skilled nursing community in Hillsboro, Oregon. Over the past three decades, that foundation has grown into a leading provider of skilled nursing, post-acute rehabilitation, and senior living across the Pacific Northwest and beyond....

Salary listed on 58 jobs
IndustryHospitals and Health Care
TypePrivately Held
Size5,001-10,000 employees
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