As a per diem Medical Social Worker, you will provide psychosocial support, assessment, and care coordination to patients and families receiving home-based services. The role addresses emotional, social, financial, and environmental factors that affect health and recovery, supports safe and effective care transitions, and works closely with the interdisciplinary team to connect patients with community resources and provide counseling. You will help patients and families manage health-related concerns, deliver social work services according to the plan of care, communicate changes in clinical status, educate patients and care team members, and perform care-planning, transfer, and discharge functions. You will also identify environmental risks to patients’ health and coordinate appropriate interventions with physicians and other members of the healthcare team.