Job Summary: The Social Worker’s responsibility is to focus on identifying Multi-Visit Patients (MVPs) using internal data and identified criteria to work closely and collaboratively with Emergency Department (ED), Inpatient Services and community-based partners to develop strategies to decrease unnecessary hospital ED utilization. In this position, the social worker will Identify utilization patterns, drivers of utilization and develop a plan of care to create alternative resources and sites to meet the identified non-hospital/non emergent patient needs. The Multi-Visit Patient (MVP) Method is an evidence-based, person-centered, locally adaptable and operationally feasible methodology for improving care. Social Workers provide comprehensive psycho-social assessment, management and support to at risk patients and families. In addition, the social worker addresses social determinants of health and complex issues, working closely with the multidisciplinary team. The candidate shall ga...