The provision of these job responsibilities are mandated by the Centers for Medicare & Medicaid (CMS) for Medicare-approved transplant centers. As a member of the transplant team, the social worker must possess specialized clinical knowledge and advanced clinical skills to help in the areas of assessment, treatment of medical, patient/caregiver navigation, mental health and behavioral disorders, and discharge planning. Responsibilities include designing and facilitating support groups and other programs, attending multidisciplinary rounds as mandated by CMS, identifying appropriate resources for financial, insurance, transportation, housing, healthcare, mental health, spiritual services, and education about diagnosis and transplantation. Develop behavioral agreements with patient and/or families addressing adherence and commitment to treatment plan. Assist with patient fundraising. Help patients comprehend complex instructions, resolve conflicts, facilitate conflict resolution, and communicate effectively verbally and in writing. May supervise and/or train new staff, students, and interns. Interview and assess patients and/or family, caregivers, and/or legal representatives. Perform comprehensive psychosocial assessments for pre-, post-, and living donors to determine transplant candidacy and continue to work with patient and family through all phases of the transplant process during inpatient and outpatient and end of life. Determine, prioritize, provide and/or arrange for needed internal and external services/interventions. Provide crisis intervention for patients and family members. Participate in transplant selection committee meetings. Consult and collaborate with multidisciplinary transplant providers as mandated by CMS to promote, monitor, and evaluate patient's ability to understand and adhere to treatment plan and lifestyle changes. Make appropriate referrals to community agencies such as DCF, APS, SSA, CMS, disease-specific resources as deemed necessary. Requires critical thinking skills, effective communication skills, decisive judgment, and ability to work with minimal supervision in a stressful and fast-paced environment. Must have strong organizational, priority setting, and multi-tasking skills. Minimum of two years post MSW experience in related field required. Previous hospital experience required. On-going clinical transplant education required. Participation in Quality Assurance and Performance Improvement (QAPI).