The Medical Social Worker provides coordinated care in clients’ homes for people of all ages. The role includes psychosocial assessment, analysis, counseling, and referrals to address the needs of clients and their families. The social worker assists with client admission by evaluating psychosocial, financial, environmental, and community needs, and documents findings through plans of care, clinical records, conferences, and community resource referrals. The position collaborates with the interdisciplinary team, communicates with clients, families, team members, and other health care professionals, and participates in case conferences and team meetings. The employee is expected to maintain professional competency, meet continuing education requirements, and maintain required certifications. The position works mostly in an office environment, with local travel and possible after-hours availability for emergencies.