Assess patient/families for goals of treatment, psychosocial factors impacting healthcare, preferences for post-acute care, barriers to discharge, available resources. - Collaborate with agencies/providers/payors that currently are engaged with patient, to ensure coordination of care. - Identify and assist in transitioning patient to post–acute care resources and options - Partner with primary team to set expectations for patients/families about timelines for choosing specific post-acute care options. - Bridge communication between care team and patient/family with focus on patient’s goals, incorporating cultural or family issues impeding progression of patient care and discharge. - Provide intervention/referrals for mental health, substance abuse, abuse/neglect/interpersonal violence. - Provide counseling and support during emergent issues and/or changes in status that may impact patient’s outcome. - Triage new referrals and assign caseloads. REQUIRED POSITION QUALIFICATIONSA Master of Social Work Degree from a program accredited by the Council on Social Work Education AND one year of full-time social work experience in a health care setting or equivalent. Experience can include a practicum placement as part of a social work training program and/or employment experience. LEGAL REQUIREMENT - Within 90 days of hire must hold one of the following credentials issued by the state of Washington: - Agency Affiliated Counselor - Licensed Social Work Associate -Advanced - Licensed Social Work Associate - Independent Clinical - Licensed Advance Social Worker - Licensed Independent Clinical Social Worker ABOUT UW MEDICAL CENTER-MONTLAKEUW Medical Center is an acute care academic medical center located in Seattle with two campuses: Montlake and Northwest. As the No. 1 hospital in Seattle and Washington State since 2012 (U.S. News & World Report) and nationally ranked in seven specialties, UW Medical Center prides itself on compassionate patient care as well as its pioneering medical advances. The UW Medical Center-Montlake campus is located on the edge of the beautiful UW campus which includes many amenities available to our staff as well as very convenient public transit options including the Sound Transit’s light rail station across the street. Excellence. Exploration. Education. ABOUT UW MEDICINE – WHERE YOUR IMPACT GOES FURTHERUW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals. All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest. Become part of our team. Join our mission to make life healthier for everyone in our community.