Social Worker MSW - Unhoused Community Care

**Description**



This position provides psychosocial assessments and re-assessments, family consultation, supportive counseling, support groups, information and referral, and education for the target population. Maintain a caseload of clients by monitoring individual plans of client self-care, coordination of services and ensuring follow-up on grant funded services for clients and their care recipients.



Provides support to and builds relationships with high risk, homeless and mental health patients who are frequent emergency department admissions and /or who discharged from the hospital to ensure a successful transition from ED/ hospital to the community and to reduce re-admissions to the ED/hospital. Support includes ensuring patient has housing, follow-up physician and ancillary appointments, arranges transportation to medical appointments if needed, and is receiving the equipment and services prescribed in the patients discharge plan. This will b...