Cynet HealthTravel Licensed Master Social Worker (LMSW) in Southgate, MI Cynet HealthTravel Licensed Master Social Worker (LMSW) in Southgate, MISouthgate, MIAssess and document the needs of clients who present for outpatient mental health and/or co-occurring substance abuse services using person-centered planning principles. Hours per Shift: Various Experience: Minimum of one year working with individuals diagnosed with mental illness, including fieldwork or internship.
Pride HealthTravel Licensed Social Worker (LSW) in Southgate, MI Pride HealthTravel Licensed Social Worker (LSW) in Southgate, MISouthgate, MIResponsibilities include assessing client needs, developing care plans, connecting individuals to community services, and advocating for their well-being. A Social Worker provides support and resources to individuals and families facing social, emotional, and health-related challenges.
HeadwayLicensed Clinical Social Worker (LCSW) HeadwayLicensed Clinical Social Worker (LCSW)Ann Arbor, MIHeadway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
HeadwayLicensed Clinical Social Worker HeadwayLicensed Clinical Social WorkerAnn Arbor, MIHeadway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
HeadwayLicensed Clinical Social Worker - Telehealth HeadwayLicensed Clinical Social Worker - TelehealthDetroit, MIHeadway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
SkyBridge HealthcareNewTravel Licensed Social Worker (LSW) in Southgate, MI SkyBridge HealthcareTravel Licensed Social Worker (LSW) in Southgate, MISouthgate, MIWhether you are an experienced traveler, or this is your first travel position, SkyBridge Healthcare puts our Nurses first and ensures a seamless travel experience. SkyBridge Healthcare wants the best for our employees, and we are dedicated to helping professionals land their ideal travel assignment.
HeadwayLicensed Clinical Social Worker (Remote) HeadwayLicensed Clinical Social Worker (Remote)Detroit, MIRemoteHeadway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
HeadwayLicensed Clinical Social Worker (Virtual) HeadwayLicensed Clinical Social Worker (Virtual)Ann Arbor, MIHeadway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more.
Sheffield Manor Nursing and RehabNewMDS Coordinator Sheffield Manor Nursing and RehabMDS CoordinatorDetroit, MIIs prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator. See Ciena Healthcare Management Privacy Policy at https://apploi.com/privacy_policy/ and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Regency at Whitmore LakeNewMDS Nurse Regency at Whitmore LakeMDS NurseWhitmore Lake, MIIs prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator. See Ciena Healthcare Management Privacy Policy at https://apploi.com/privacy_policy/ and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Regency at Whitmore LakeNewMDS Nurse - Sign On Bonus Regency at Whitmore LakeMDS Nurse - Sign On BonusWhitmore Lake, MIRemoteIs prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator. See Ciena Healthcare Management Privacy Policy at https://apploi.com/privacy_policy/ and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
IMCS Group IncPerm - Social Worker / Supervisor - Adult Behavioral Health / Social Work (Days) Southgate, MI IMCS Group IncPerm - Social Worker / Supervisor - Adult Behavioral Health / Social Work (Days) Southgate, MISouthgate, MIPaid holidays include: New Year s Eve and New Year s Day, Martin Luther King Day, day for Good Friday, Memorial Day, Juneteenth, 4th of July, Labor Day, Thanksgiving and the day after (Black Friday), Christmas eve and Christmas Day. As a recognized leader in our field, The Guidance Center provides a broad range of services that have helped children, adults and families unlock potential and build better lives since 1958.
Veracity Software IncSupervisor - Social Work (Days) Veracity Software IncSupervisor - Social Work (Days)Southgate, MITentative Start Date: Motivation / Reason for interest in this position: Reason for job change: Contact Number: Email ID: LinkedIn Profile URL: Full Address (City, State): Notice Period / Availability: Current Work Authorization Status: Expected Salary: Are you ready to relocate at your own expense and work onsite in Southgate, Michigan?. This role requires leadership experience, strong clinical knowledge, and the ability to support both patients and interdisciplinary teams.
University Health Services IncSocial Work Associate - PRN Weekend University Health Services IncSocial Work Associate - PRN WeekendAUBURN HILLS, MIOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. • Provides group therapy, individual therapy, family therapy, substance abuse group/didactic, and/or couples therapy as deemed appropriate by the treatment team, the treating psychiatrist, Director of Clinical Services and/or Lead Social Work.
PACE Southeast MichiganSocial Work - Pontiac PACE Southeast MichiganSocial Work - PontiacPontiac, MichiganThe MSW provides care through a variety of modalities, including but not limited to bio-psychosocial assessment, interventions that include cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management. The Master’s Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers.
McLaren Health Care CorpSocial Worker Master of Social Work McLaren Health Care CorpSocial Worker Master of Social WorkClarkston, MIPosition Summary: Provides assessment and intervention to assist clients/families to improve social and economic difficulties interfering with health and wellness through use of casework process and principles, strategies, and community resources. Position/Subsidiary Specific: Required: Valid driver's license, proof of valid auto insurance coverage at all times and maintain a driving record in accordance with McLaren's corporate driving policy and eligibility guidelines.
HonorVet TechnologiesSocial Work - MSW HonorVet TechnologiesSocial Work - MSWDetroit, MIWe are seeking an experienced and compassionate Master's-level Social Worker (MSW) to provide comprehensive social work services within a healthcare setting. This role involves supporting pediatric and adolescent populations, collaborating with families and interdisciplinary teams, and facilitating effective care plans.
Henry Ford HospitalDirector of Behavioral Health - Social Work Henry Ford HospitalDirector of Behavioral Health - Social WorkDetroit, MIThe Director works collaboratively with Henry Ford Health Service Line leadership, Clinical Councils, hospital senior leadership, medical directors, patient care teams, physicians (both employed and community), and outside agencies to provide state-of-the-art care in the community. GENERAL SUMMARY: Reporting to the Vice President, Behavioral Health Service Line, the Director of Behavioral Health, Social Work provides overall operational and strategic leadership for the acute medical and emergency department psychiatric social workers across the care delivery continuum.
Apidel TechnologiesSocial Work - MSW Apidel TechnologiesSocial Work - MSWDetroit, MIContractorRequired Certifications & Licensure: Current licensure as a Social Worker in the State of Michigan: Masters Social Worker license (LMSW) OR Limited Masters Social Worker License (LLMSW). Required: 5%2B years case management experience with 2%2B years recent acute inpatient case management experience, Master of Social Work, LMSW licensure in the state of MI, Discharge planning experience.
McLaren Health Care CorpSocial Work Care Manager McLaren Health Care CorpSocial Work Care ManagerDetroit, MIProvides professional discharge planning services through assessments, and coordination of post hospital care needs to patients and their families; providing them with resources and choices to effectively link them to the needed level of emotional, medical and spiritual care. Assesses patient and family needs for support and community service needs (Meals on Wheels, Sitters, etc.); educates and refers them to community resources, access to services, arrange for appointments and establishes rapport with other agencies.
Trinity HealthSocial Work Lead Trinity HealthSocial Work LeadAnn Arbor, MIBLOOD/FLUID EXPOSURE RISK: (check the right category) N/A___ Category I: Tasks involve exposure to blood, fluids or tissue x_ Category II: Usual tasks do not involve exposure to blood, body fluid, or tissues but job may require performing unplanned Category I tasks. PHYSICAL REQUIREMENTS AND WORK ENVIRONMENT: Check the frequency and number of hours a day the worker is required to do the following specific types of activities: | ACTIVITY | FREQUENCY | N/A | RARELY (0-25%) | OCCASIONALLY (25-50%) | FREQUENTLY (50-75%) | CONTINUALLY (75-100%) | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | a.
MADONNA UNIVERSITYFT- Social Work MADONNA UNIVERSITYFT- Social WorkLivonia, MIThe position begins August 202 6. Madonna University is a Franciscan, Catholic co -educational liberal arts university located in Livonia, Michigan, a western suburb of the metropolitan Detroit area, with a student body that is an exciting and diverse mix of traditional and non -traditional students. POSITION ANNOUNCEMENT Job Title: Full-Time Social Work Faculty Department: Social Work Reports To: Dean, College of Education and Human Development Madonna University invites applications for a full -time faculty position at the rank of assistant or associate professor in our Bachelor of Social Work P rogram.
OAKLAND SCHOOLS31N Grant Funded – General Education Elementary Mental Health Professional (Social Work or Counseling) - (2026-2027 School Year) OAKLAND SCHOOLS31N Grant Funded – General Education Elementary Mental Health Professional (Social Work or Counseling) - (2026-2027 School Year)Oakwood, MIThe district has approximately 1,000 students in junior kindergarten-5th grade between the two elementary schools, approximately 550 at the middle school level and approximately 850 at the high school. Administer a comprehensive behavioral health assessment, including the use of screening tools as indicated, to determine student needs for specific psychological, health or related services.
University Physician GroupSocial Work Intern-2 University Physician GroupSocial Work Intern-2Livonia, MichiganUnder the direction of a licensed social worker (Social Worker II), provides biopsychosocial assessments and treatment interventions through the use of structured educational and therapeutic groups and individual treatment formats. Provides for a multi-disciplinary approach to treatment by coordinating with other staff and with persons identified by the patient; coordinates care with referring physician or agencies; assesses patient progress and modifies the treatment plan accordingly.
University Physician GroupSocial Work Intern-1 University Physician GroupSocial Work Intern-1Livonia, MichiganUnder the direction of a licensed social worker (Social Worker II), provides biopsychosocial assessments and treatment interventions through the use of structured educational and therapeutic groups and individual treatment formats. Provides for a multi-disciplinary approach to treatment by coordinating with other staff and with persons identified by the patient; coordinates care with referring physician or agencies; assesses patient progress and modifies the treatment plan accordingly.
Corewell HealthSocial Work Navigator LMSW Corewell HealthSocial Work Navigator LMSWSouthfield, MichiganInterventions may include outpatient psychiatrist appointments, supporting medication adherence, facilitating referrals, identifying care goals, coordinating access to crisis centers, and working with community mental health and local mental health providers to promote safe transitions. Essential FunctionsSupport patients and families in navigating behavioral health services and resources across acute and community settings, using in-person, electronic, and telephonic communication to bridge care gaps.
Corewell HealthClinical Social Work MSW Emergency Department Casual Corewell HealthClinical Social Work MSW Emergency Department CasualRoyal Oak, MIThese interventions may include, but are not exclusive to: alternate site coordination, discharge planning, addressing all forms of identified abuse/neglect, adoption, substance use disorders, assisting with end of life decisions, providing appropriate referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). Conducts psychosocial assessments with patient and or family to assist with identified psychosocial needs or who may be identified to require an alternate site of care post discharge and executes a plan.
Trinity HealthDirector of Social Work - Fraser Villa Trinity HealthDirector of Social Work - Fraser VillaFraser, MIIf you provide content to customers through CloudFront you can find steps to troubleshoot and help prevent this error by reviewing the CloudFront documentation. Generated by cloudfront CloudFront Request ID: 5gcZwDnXJhbPP8yzSSuzaOpoY4150vpkdPS-d7ZL1rL6yCGwlPzCWA.
Lahser Hills Care CenterDirector of Social Services - LSW Lahser Hills Care CenterDirector of Social Services - LSWSouthfield, MIAssist in meeting the psychological needs of each resident, including developing and managing services to improve social functioning, reduce psychosocial problems, enhance positive self-image, and preserve dignity. Bachelor’s Degree in Social Work; Master’s Degree in Social Work preferred; a minimum of a Limited License in Social Work required; LBSW/LMSW preferred.
University of MichiganSocial Worker MSWMSW SR - 1.0 FTE Social Worker BHCC - OBGYN and BHCC Float - Full Time - Day Shift Mon-Fri University of MichiganSocial Worker MSWMSW SR - 1.0 FTE Social Worker BHCC - OBGYN and BHCC Float - Full Time - Day Shift Mon-FriAnn Arbor, MIRemoteThis role provides integrated behavioral health services using the Collaborative Care Model (CoCM), including psychosocial assessment, brief evidence-based interventions, symptom monitoring, care coordination, safety planning, and psychiatric case consultation support. The BHCM works closely with medical providers, psychiatric consultants, and interdisciplinary care teams to deliver timely, measurement-based care for patients experiencing depression, anxiety, perinatal mood concerns, and other behavioral health needs.
Acadia Healthcare Co IncSocial Worker Supervisor Acadia Healthcare Co IncSocial Worker SupervisorNew Baltimore, MILICENSES/DESIGNATIONS/CERTIFICATIONS: State licensure, as required by the state in which the facility operates; which could include: Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Social Worker (LSW). What you will do as a Social Worker Supervisor: Plan, direct, define and coordinate individualized and group therapeutic support and services to patients with behavioral problems, psychiatric disorders, post-traumatic stress disorder, substance use and physical and emotional abuse.
Rivergate TerraceSocial Services Director Rivergate TerraceSocial Services DirectorRiverview, MichiganImplement a social services program that meets the medically related social and emotional needs of patients as well as State, Federal, corporate, and division guidelines. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Life Care Centers of America IncSocial Services Director Life Care Centers of America IncSocial Services DirectorRiverview, MIImplement a social services program that meets the medically related social and emotional needs of patients as well as State, Federal, corporate, and division guidelines. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Schoolforce Solutions IncSchool Social Worker Schoolforce Solutions IncSchool Social WorkerDetroit, MILicensed Master Social Worker (LMSW) or Limited Licensed Master Social Worker (LLMSW) preferred. Work-Life Balance: Enjoy contracts up to 40 hours per week, unlike salaried positions, you would be paid time 1.5 for anything approved over 40 hours by your supervisor.
Schoolforce Solutions IncSchool Social Worker (SSW) Schoolforce Solutions IncSchool Social Worker (SSW)Allen Park, MI$49–$62 / hourLicensed Master Social Worker (LMSW) or Limited Licensed Master Social Worker (LLMSW) preferred. Work-Life Balance: Enjoy contracts up to 40 hours per week, unlike salaried positions, you would be paid time 1.5 for anything approved over 40 hours by your supervisor.
Henry Ford HospitalSocial Worker - Case Management - Part Time 20 hrs./week - Days - Southfield Henry Ford HospitalSocial Worker - Case Management - Part Time 20 hrs./week - Days - SouthfieldSouthfield, MIServes as a resource to assess, evaluate, recommend and treat legal, neglect, substance abuse, crisis, psychosocial and various adjustment needs. Additional Information Organization: Henry Ford Providence Hospitals Department: Social Service 001 Shift: Day Job Union Code: Not Applicable.
Rivergate Health Care CenterSocial Worker Rivergate Health Care CenterSocial WorkerRiverview, MichiganPlan, organize, develop, and implement social services program that meets the medically-related social and emotional needs of patients as well as State, Federal, corporate, and division guidelines. Knowledgeable of social services practices and procedures as well as the laws, regulations, and guidelines governing social services functions in the post-acute care facility.
Life Care Centers of America IncSocial Worker Life Care Centers of America IncSocial WorkerRiverview, MIPlan, organize, develop, and implement social services program that meets the medically-related social and emotional needs of patients as well as State, Federal, corporate, and division guidelines. Knowledgeable of social services practices and procedures as well as the laws, regulations, and guidelines governing social services functions in the post-acute care facility.
Harbor Oaks HospitalSocial Worker Supervisor Harbor Oaks HospitalSocial Worker SupervisorNew Baltimore, MichiganWhat you will do as a Social Worker Supervisor: Plan, direct, define and coordinate individualized and group therapeutic support and services to patients with behavioral problems, psychiatric disorders, post-traumatic stress disorder, substance use and physical and emotional abuse. State licensure, as required by the state in which the facility operates; which could include: Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Social Worker (LSW).
The Salvation Army USASocial Service Coordinator The Salvation Army USASocial Service CoordinatorFarmington Hills, MIMeets with applicants and assists with application processes • Assesses needs for food, utilities, housing, shelter, emotional support, and spiritual care • Determines eligibility for resources • Develops plans to address the presenting problem • Provides information on resources • Utilizes a person-centered approach to educate applicants utilizing a financial toolkit • Coaches applicants on ways to reduce energy consumption as applicable • Facilitates the case management of families utilizing the Pathway of Hope guidelines and assessment tools • Develops rapport and partnership with families • Develops case plans and supports participants in establishing goals • Meets regularly to track progress • Coordinates referrals and works to strengthen family sufficiency. • Complete Safe From Harm certification and keep current as needed • Must have and maintain a current valid drivers license and pass the Salvation Army Motor Vehicle Record check (MVR).
University Health Services IncSocial Worker - PRN University Health Services IncSocial Worker - PRNAUBURN HILLS, MIOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. Provides group therapy, individual therapy, family therapy, substance abuse group/didactic, and/or couples therapy as deemed appropriate by the treatment team, the treating psychiatrist, Director of Clinical Services and/or Lead Social Work.
University Health Services IncSocial Worker - Full Time University Health Services IncSocial Worker - Full TimeAUBURN HILLS, MIOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. • Provides group therapy, individual therapy, family therapy, substance abuse group/didactic, and/or couples therapy as deemed appropriate by the treatment team, the treating psychiatrist, Director of Clinical Services and/or Lead Social Work.
University Health Services IncInpatient Case Manager (Social Worker)- PRN University Health Services IncInpatient Case Manager (Social Worker)- PRNAUBURN HILLS, MIOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. • Provides group therapy, individual therapy, family therapy, substance abuse group/didactic, and/or couples therapy as deemed appropriate by the treatment team, the treating psychiatrist, Director of Clinical Services and/or Lead Social Work.
Southeast MichiganMedical Social Worker Southeast MichiganMedical Social WorkerSouthfield, MichiganProvide appropriate crisis intervention/treatment to adults, children, and families in emergency situations including assessment, counseling, information/referral, and providing consultation to physicians and the healthcare team. As a member of our team, you’ll play a key role in providing quality home healthcare, where patients are able to remain independent at their place of residence in the healthiest and happiest state of being possible.
NexCare WellBridge Senior LivingSocial Worker - LSW NexCare WellBridge Senior LivingSocial Worker - LSWDetroit, MICoordinating discharge planning services, i.e., helping to place a resident on a waiting list for community congregate living, arranging intake for home care services for residents returning home, assisting with transfer arrangements to other facilities. Bachelor’s Degree in Social Work, or in related human services field, including but not limited to Sociology, Special Education, Rehabilitation Counseling, and Psychology; must have a minimum of a Limited License in Social Work LSW Required; LBSW preferred.
State of MichiganSocial Services Division Administrator 17 - Michigan Youth Treatment Center State of MichiganSocial Services Division Administrator 17 - Michigan Youth Treatment CenterMount Clemens, MI$46.39–$76.92 / hourGreat Lakes and Great Times: Michigan boasts four Great Lakes, 11,000 inland lakes, 36,000 miles of rivers and streams, 20 million acres of forests, 100 state and national parks and recreation areas, 1,300 miles of bike trails, 6,500 miles of snowmobile trails, the second-most ski areas in the nation, 650 public golf courses, 600 campgrounds, and an international dark-sky parkjust for starters. If you selected that you have been dismissed with in the last two years, resigned in lieu of dismissal within the last two years, suspended without pay within the last two years, received a written reprimand within the last two years, received an unsatisfactory rating within the last two years, or signed a last chance agreement with MDHHS within the last two years, please provide an explanation below.
PACE Southeast MichiganSocial Worker - Clinton Twp PACE Southeast MichiganSocial Worker - Clinton TwpClinton Township, MichiganThe MSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management. POSITION SUMMARY: Under the leadership of the Social Work Manager, the Masters Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers.
PACE Southeast MichiganSocial Worker - Eastpointe PACE Southeast MichiganSocial Worker - EastpointeEastpointe, MichiganThe MSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management. POSITION SUMMARY: Under the leadership of the Social Work Manager, the Masters Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers.
PACE Southeast MichiganSocial Worker - Detroit Greydale PACE Southeast MichiganSocial Worker - Detroit GreydaleDetroit, MichiganThe MSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management. POSITION SUMMARY: Under the leadership of the Social Work Manager, the Masters Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers.
Tenet Healthcare CorpSocial Worker - Case Management Tenet Healthcare CorpSocial Worker - Case ManagementDetroit, MIThis individual's responsibility will include the following activities: a) complex psycho-social transition planning assessment and reassessment and intervention, b) assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies, c) care coordination, d) implementation or oversight of implementation of the transition plan, e) leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review, f) making appropriate referrals to other departments, g ) communicating with patients and families about the plan of care, h) collaborating with physicians, office staff and ancillary departments, i) assuring patient education is completed to support post-acute needs , j) timely complete and concise documentation in Case Management system, k ) maintenance of accurate patient demographic and insurance information, l) and other duties as assigned. The Social Worker is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination.