The Social Work Care Coordinator (MSW) will coordinate team-based care to provide health services and education to patients and families through effective partnerships with Delaware Children Health Network (DCHN) practices, community resources and medical professionals. Provides Care Coordination in the DCHN practice setting by utilizing critical thinking skills and social worker expertise in order to optimize patient outcomes amongst designated populations within the practice. Works with patients and families to ensure both behavioral and psychosocial needs are met. Works with DCHN practices to address gaps in care and promote