Social Worker (MSW)

**Description** Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well\-being of the communities we serve across North Carolina. Summary: A Social Worker – Ambulatory II is an integral member of the healthcare team, providing comprehensive support and services to patients and their families. They play a vital role in promoting mental, emotional, and social well\-being. The Clinical Social Worker is responsible for a range of duties, including conducting assessments, developing patient\-centered care plans, facilitating resources, monitoring progress and evaluation, advocating for patients, actively listening to their concerns, respecting individuality, and building trust. Responsibilities: 1\. Assessments: Conduct comprehensive biopsychosocial assessments to evaluate patient needs and identify any barriers to their overall functioning. This includes assessing their support systems, coping mechanisms, mental health conditions, and psychosocial factors. 2\. Patient\-Centered Care Plans: Collaborate with the healthcare team and the patient to develop individualized care plans that address their unique needs, goals, and preferences. These plans should integrate medical, psychological, and social aspects of care to ensure a holistic approach. Plans should facilitate optimal patient care transitions to avoid unnecessary hospitalizations or emergency department utilization. 3\. Resource Facilitation: Connect patients and their families with community resources, mental health services, support groups, and other relevant programs. This includes assisting with referrals for psychiatric evaluations, medication management, and coordinating care with other providers. Educates patients and their families on available resources. Coordinates and delivers patient education, referrals, and transitions of care, including referrals for home health, hospice, DME, and long\-term care. 5\. Documentatio