The Case Management Social Worker performs effective assessments of patients and their families. Based on the needs identified in an assessment, the Social Worker arranges, coordinates, and monitors multiple services from different providers to meet patients needs. The Social Worker addresses the psychological and social needs of the patients and formulates the discharge plan in collaboration with all appropriate team members. Under the guidance of the Case Management Supervisor, the Social Worker is responsible for conducting and coordinating patient assessments, transition of care, discharge planning affecting patient outcomes, and patient/family education.