Adriana Aguirre
Vancouver
Summary
Seasoned Social Service Specialist offering over eight years of comprehensive experience in the behavioral health field. Skilled at developing assessments, quickly building trust and rapport with clients from diverse cultures. Highly adept at case planning with effective communication. Services clients to promote optimum mental, emotional and behavioral health in collaboration with other members of health care team.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Case Manger 2
Multnomah Co-Aging, Disability & Veterans Services
08.2024 - Current
- Maintain an ongoing caseload to determine eligibility and accuracy of benefits; process and maintain case records and monthly reporting forms; compute overpayments and respond to client inquiries.
- Interview Medicaid and food stamp applicants, recipient's relatives, guardians, and their representatives to determine and document initial and ongoing eligibility and financial needs in accordance to Federal and State guidelines
- Provide eligibility re-determination when financial or medical status changes occur; screen for unmet needs such as health care and social services.
- Complete required documentation and benefit-generating actions; follow up with collateral contacts to obtain required information; assess forms for accuracy; document income, resources, and client situation on forms.
- Provide housing referrals, stable housing plans, and medical transportation to clients; make internal referrals for ongoing case management and community services.
- Provide ongoing support to clients and their families; serve as an advocate for clients with managed health care plans; assist client with hearings requests and attend as a witness or unit representative.
- Respond to crisis situations involving clients by making referrals to Mental Health, Crisis Line, Adult Protective Services, Senior Law Clinic, Service Intake, and other services; collaborate with internal staff to provide or arrange medical, financial, and social services for individuals with complex psycho-social or medical problems requiring ongoing assistance.
- Perform complex case management duties, including assessing, evaluating, and documenting eligibility for full spectrum Federal and State program services and benefits; provide referrals to resources when applicant becomes ineligible for Medicaid programs.
- Conduct comprehensive needs assessment with consumer, their family, guardian, and collateral contacts to develop an accurate portrayal of client's strengths, needs, choices, and risks
- Develop service plans with appropriate levels of service and risk mitigation; coordinate care planning, engage in problem resolution, and facilitate referrals with agencies and individuals such as doctors, attorneys, guardians, and community partners; ensure that the service plan fully addresses assessed care needs such as behavioral support services, home health care, emergency response systems, and others; monitor and adjust the client's long-term care services
- Engage in transition and diversion activities or referrals for consumers in acute or nursing facility settings
- Coordinate discharge and relocation plans for a safe transition to a community-based care setting
- Participate on committees, work groups, and in identifying needed policy and systems issues and potential improvements.
Behavioral Health Resource Specialist
Oregon Health and Science University
04.2023 - 11.2023
- Provided intervention around the social determinations of health through proactive patient identification
- Schedule patient follow-ups
- Assessments
- Crisis intervention
- Participated in behavioral health case management as part of multi-disciplinary team to address complex patient needs appropriately
- Provided short-and long-term involvement and a high level of coordination with internal and community-based resources
- Maintained a professional presence and actively engaged with teams
- Documented services appropriately in Electronic Health Record in existing workflows to ensure continuity of care
- Maintained technology fluency for both in-clinic and telehealth care.
Social Service Specialist 2
Washington State-Department of Human and Social Services
07.2021 - 11.2021
- Conducted assessments to determine a person's level of functioning including evaluating education, social history, living situation, and employment history as well as physical and behavioral health status
- Developed individualized care plans to provide specific action steps from assessment findings
- Utilized a variety of computer databases to maintain daily reports and document case activities
- Screened and referred people for medical, psychiatric, and other tests
- Reviewed and interpreted medical reports and test results to determine eligibility for programs
- Authorized additional referrals to medical specialists when indicated by medical evidence
- Stayed up to date on community resources and referral sources for medical, behavioral health, and chemical dependency.
Behavioral Consultant
Altoris Behavior Support
04.2017 - 04.2021
- Helped individuals with Dementia, TBI, or other challenging behaviors to attain and maintain a maximum level of emotional and social functioning
- Made recommendations to provider on how to engage and work with client to help de-escalate behaviors
- Conducted follow-up consultations to reinforce behavior support plan
- Worked with case managers (state and county), PCPs, care teams to secure/maintain placement (AFH, RCF, Nursing facility, independent living)
- Traveled to and from different client locations, providers offices etc
- Developed clearly written behavior support plans using Microsoft Word, Excel, Power point etc
- For providers to help clients remain in their current residence or to move to an appropriate setting as care needs change
- Researched ideas and supports on community resources to help providers and clients gain knowledge of programs available to them
- Provided client advocacy, consultation, networking, family support, and education to others about services provided
- Conducted and completed face-to-face comprehensive person-centered evaluations at the clients' residence (in-home or residential care settings) to learn more information on client preferences
- Facilitated all staff trainings via zoom or in person to make sure care plan is understood by all staff
- Gathered feedback and revised plans
- Reached out to providers, guardians, providers, family members to provide up to date information.
Behavioral Health Specialist
The Guidance Center
10.2014 - 05.2016
- Provided support and assistance to Provider and consumers
- Made recommendations to Provider relative to psychological intervention strategies
- Conducted follow-up consultations to reinforce Provider generated interventions
- Assisted consumers with medication administration
- Engaged in daily activities with consumers in helping them to obtain their specific treatment goals
- Led/taught group exercises/topics of discussion with consumers and gathered feedback
- Transported consumers to and from doctor’s appointments provided by The Guidance Center
- Inscribed Progress Notes reporting activities performed towards consumer’s treatment goals.
Education
Master of Social Work (MSW) - Social Work
Portland State University
Portland, OR04-2026
Bachelors Social Work (BSW) - Social Work
Northern Arizona University
Flagstaff, AZ01.2016
Associates in Behavioral Science - Behavioral Sciences
Imperial Valley College
Imperial, CA01.2013
Skills
- Multitasking
- Team Collaboration
- Professionalism
- Problem-solving abilities
- Active Listening
- EHR Documentation
- Excellent Communication
- Relationship Building
- Self Motivation
- Professional Development
- Microsoft Office
- Reliability
- Organizational Skills
- Goal Setting
- Written Communication
- Adaptability
- Working with Diverse People
- Strong work ethic and integrity
- HIPAA Compliance
- Clinical Documentation
Certification
ASIST certification
Volunteer Experience
Multnomah County - Aging, Disability and Veteran Services
Served as intern to agency and helped with making contact with client, completing assessments, tabling at community events, provided information to community members on services available, completion of trainings of agency, attended trainings to develop more skills when working with clients, learning Medicaid services, assist with placement and coordination of clients.
The Peaks Senior Living Community, 01/2015, 03/2015, Flagstaff, AZ,
Helped residents with morning activities such as exercise and tidying up., Provided residents with companionship., Helped with preparing for special events., One-on-one visits with residents., Entertaining residents., Assisting with outings., Clerical support.
References
References available upon request
Timeline
Case Manger 2
Multnomah Co-Aging, Disability & Veterans Services
08.2024 - Current
Behavioral Health Resource Specialist
Oregon Health and Science University
04.2023 - 11.2023
Social Service Specialist 2
Washington State-Department of Human and Social Services
07.2021 - 11.2021
Behavioral Consultant
Altoris Behavior Support
04.2017 - 04.2021
Behavioral Health Specialist
The Guidance Center
10.2014 - 05.2016
Bachelors Social Work (BSW) - Social Work
Northern Arizona University
Associates in Behavioral Science - Behavioral Sciences
Imperial Valley College
Master of Social Work (MSW) - Social Work
Portland State University
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