Working under department management, the Social Worker partners with the Clinical Care Transitions Manager and other health care professionals to support continuity and coordination of care for patients and families. The role provides consultation about social, environmental, psychological, financial, and cultural factors related to illness and hospitalization, supports continuity in care management, and coordinates all aspects of discharge planning. The Social Worker provides services in Emergency, PCU, and Medical Surgical settings. The position includes supportive counseling, psychosocial and behavioral health interventions, crisis response, community-resource assessment, referrals, and coordination with patients, families, care providers, and outside agencies. The role maintains appropriate patient-contact documentation and follows the National Association of Social Workers Code of Ethics.