Motivated social worker with comprehensive knowledge of medical social work. Including, but not limited to: discharge planning, advocating for in-patient and out-patient health needs, social determinants of health assessments, transition planning, hospice care, crisis intervention and other psycho-social issues. Skilled at supporting patients with medical forms such as POA, POLST, COPES and more. Continually working with multidisciplinary team members including: providers, DCR's, law enforcement, therapists, kidney centers, drug/alcohol rehab facilities and various other resources withing the community. Skilled in cultural diversity and inclusion of all marginalized population groups.