Hospice Referral Coordinator – Social Worker

About the role

The Hospice Referral Coordinator Social Worker joins Cleveland Clinic Health System to support patients transitioning from hospital to hospice care. Working within the interdisciplinary team, you will manage referrals, ensure continuity of care, and coordinate discharge planning across multiple east‑region hospitals.

Key responsibilities

• Process inpatient hospice referrals, coordinate supplies, DME, and hand‑off communication with field teams.
• Conduct initial assessments within three days of admission and develop individualized plans of care.
• Visit patients and families according to the care plan, providing counseling, safety assessments, and updates to the electronic medical record.
• Coordinate daily care for General Inpatient (GIP) hospice patients and collaborate with hospital staff.

Required profile

• Master’s Degree in Social Work from a CSWE‑accredited program.
• Current Ohio LSW licensure and at least two years of relevant experience.
• Current Basic Life Support (BLS) certification.
• Knowledge of JCAHO and Medicare standards.

Required skills

• Electronic medical record (EMR) documentation.
• Basic Life Support (BLS) certification.