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Medical Social Worker (BSW or MSW)
Company : Sonoma Valley Hospital
Location : Sonoma, CA, 95476
Job Type : Full Time
Date Posted : 3 January 2026
Overview
Provides social services to patients with identified social, behavioral and/or mental-emotional needs in the inpatient and emergency department settings. Acts as a liaison with community provider agencies to develop care resource networks. Works with the multidisciplinary team to build effective care coordination planning for patients and their families with a focus on holistic care. Demonstrates a strong understanding of the physical, emotional, and social challenges associated with aging, including chronic illness, cognitive decline, and grief. Must respect the autonomy and dignity of older adults, ensuring they have a voice in their care decisions. Provides support to caregivers in managing the stress and demands of caring for an aging loved one, with a focus on preventing caregiver burnout. Assists patients and families with discharge planning, including identifying appropriate post-hospital care settings (e.g., home, rehabilitation, or long-term care) and connecting them with necessary resources.
Responsibilities
Completes assessment and coordinates discharge planning for patients with social/ behavioral/mental- emotional needs, (including dementia, depression, etc) and functional abilities.
Coordinates placement referrals for boarders, the homeless, and the under or uninsured and those with behavioral health needs, including substance abuse.
Coordinates the homeless discharge planning process, ensuring that the organization is in compliance with all requirements. Ensures departments have the resource tools to comply when social work or case management are not present. Maintains the homeless log and the clothing closet.
Serves as an advocate for patients' rights, needs, and preferences within the healthcare system, ensuring they receive appropriate and respectful care.
Provides crisis intervention to patients and their families in the acute and emergency setting with compassion, support and guidance, helping them manage the stress and challenges of caring for an aging loved one and those with mental health challenges.
Connects patients and families with community resources, including financial assistance, social services, and support groups. Assist patients and families with long-term care planning, including identifying appropriate care settings and financial resources
Builds community provider partnerships including clinics, first responders, non-profits, and county services to effectively address social needs as they present in our patient population.
Participates in Emergency Department rounding and daily inpatient morning huddles. Works in collaboration with members of the multidisciplinary team to develop and implement individualized care plans.
Assists with post discharge follow-up on high risk patients to promote primary care engagement, confirm that services are in place, and help prevent readmission. Provides followup for patients who are frequent users of the emergency department, as needed.
Maintains accurate and up-to-date records of client progress and interventions in compliance with regulatory and ethical standards.
Qualifications
Education: Bachelor's degree in Social Work from an accrediated university; Master's degree preferred.Experience: Minimum 2 years' of social services experience in the fields of aging, health, or long-term care. Previous experience with Sonoma County provider agencies & care coordination is preferred.Licenses & Certifications: California Licensed Clinical Social Worker (LCSW) preferred.Required Skills & Knowledge: Excellent written and verbal communication skills. Ability to manage priorities and workflow. Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm. Ability to deal effectively with a diversity of individuals at all organizational levels. Good judgement with the ability to make timely and sound decisions. Proficiency with computers and Microsoft Excel.
Compensation
Actual compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Eligible roles also qualify for a comprehensive benefits package.Minimum:
USD $49.31Maximum:
USD $67.81Related Jobs
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Frequently asked questions
At Sonoma Valley Hospital, Medical Social Workers provide tailored assistance addressing the unique emotional and physical challenges of aging. This involves collaborating on personalized care plans, advocating for patient autonomy, and offering caregiver support to manage stress and prevent burnout, ensuring dignified, holistic care for older adults.
Medical Social Workers in hospitals must excel in crisis intervention, discharge planning, and interdisciplinary communication. Skills in navigating healthcare systems, understanding mental health nuances like dementia or depression, and connecting patients with community resources are essential, setting them apart from broader social work roles.
They conduct thorough post-discharge follow-ups for high-risk patients, ensuring service continuity and primary care engagement. By coordinating community resources and personalized care plans, these social workers effectively lower readmission chances, which is crucial for Sonoma’s healthcare system efficiency.
Expect dynamic schedules with some flexibility, balancing inpatient and emergency department duties. The role demands adaptability to rapidly changing priorities but offers rewarding engagement with diverse patient needs, aligning well with professionals seeking meaningful healthcare social work in Sonoma.
Sonoma experiences steady demand for healthcare social workers due to its aging population and comprehensive health services. Candidates with local agency experience or California LCSW licensure often have an edge, while competition remains moderate given regional healthcare growth and resource coordination needs.
Holding a California Licensed Clinical Social Worker (LCSW) certification significantly boosts job prospects. Additionally, familiarity with local community service networks and experience with aging or behavioral health populations are highly valued by Sonoma hospitals like Sonoma Valley Hospital.
Sonoma Valley Hospital emphasizes community partnerships, including managing homeless discharge planning and maintaining resources like clothing closets. This blend of hospital and community advocacy requires social workers to adeptly navigate social services alongside acute medical care.
Medical Social Workers participate in daily inpatient huddles and emergency department rounds, collaborating closely with nurses, physicians, and other care providers. This integrated approach ensures comprehensive, patient-centered care planning that addresses both medical and psychosocial needs.
Compensation ranges roughly from $49.31 to $67.81 per hour, influenced by education level, experience, licensure like LCSW, and department equity. Sonoma Valley Hospital also offers benefits, making the overall package competitive within Sonoma’s healthcare job market.
This role uniquely combines inpatient and emergency social services with community resource coordination, including homeless discharge and caregiver support. Unlike many hospital social work jobs, it emphasizes local partnerships and holistic approaches tailored to Sonoma’s patient demographics.