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The project is an expansion of our Collaborative Care Model designed to focus on social determinants of health and resource assistance to meet the needs of the underserved population in our community. This position will screen patients for social determinants of health and then connect patients to resources that are identified through this screening. This staff member will help connect patients to resources for food, transportation, diapers, counseling services, financial aid, pharmacy, etc. This person can also help patients navigate the healthcare system by helping to make appointments in other HMC departments - such as primary care, imaging, lab, other maternal fetal medicine, diabetic education, physical therapy, other specialties, etc.