Responsibilities include assessing the psychosocial needs of the patient and family to develop, communicate, and implement an effective and
comprehensive plan for psychosocial interventions and complex discharges, included but not limited to readmissions
in the high risk population. Is a resource regarding social systems, institutions, and behavioral and relationship
patterns. Can skillfully apply the appropriate interventions to meet the needs of the patient and family. Collaborates
with the multidisciplinary team to ensure effective, efficient, appropriate care in order to optimize the health status and
assure a smooth transition between levels of care for patients served. Provides education and expertise to promote
the practice and profession of social work within the hospital.