The Rehab Social Work Case Manager utilizes professional clinical social work skills to assess patients' need and support systems for efficient discharge planning, psychosocial, counseling, and social drivers of health support needs; monitors and updates the interdisciplinary care plans as appropriate, establishes plans for effective management of the identified needs (episodic and populationbased). Assessment, planning, intervention, and reassessment are performed in a collaborative environment, in which they work closely with Medical Staff, Clinical Case Managers, Nursing, Allied Health disciplines, hospital business/financial services, and other stakeholders.