Medical social work professional with proven track record in providing compassionate and effective support to patients and families. Leveraged experience to implement care plans that address both medical and psychosocial needs. Known for strong collaboration with healthcare teams and adaptability to changing circumstances, ensuring optimal patient care and support.
Completed psychosocial evaluations and needs assessments. Connected patients with community resources, ensuring access to essential services such as housing, healthcare, and financial assistance. Maintained detailed documentation of client progress, adhering to strict confidentiality guidelines in compliance with HIPAA regulations. Coordinated individualized discharge plans to manage safe transition back into community and home environments. Explained medical care options to help families make informed healthcare decisions. Ensures timely completion of assessments and documentation per federal and state regulations and facility policies and procedures.
Ensures compliance with the PASRR (Preadmission Screening and Resident Review) process.
Interview customers/family/others as needed to obtain accurate information for Pre-Admission Screening and reassessments. Obtain/Review medical records to support the medical eligibility determination. Prepare accurate and complete documentation. Identify/prepare cases requiring physician review. Assure timeliness for work submitted. Explain assistance program benefits/responsibilities to customers. Utilize information in the program guideline, regulations, and manuals and interpret local/regional/state/federal rules and regulations, policy and procedures to facilitate eligibility determination. Represent the agency to assure the agency position in the appeal process as needed. Determine applicant's financial eligibility when applicable for ALTCS and Medicare Savings programs using the appropriate policy guidelines.
Responsible for the assessment of needs and coordination of treatment services for members identified as needing of service coordination, as identified through the use of the CASII, Assessments and Service Plans. Acts as the primary point of contact for all Child and Family Team (CFT) members to facilitate meetings and follow-up recommendations, to ensure continuity of care and service delivery, and to educate team members about the CFT process. Work with Department of Child Safety and the Division of Developmental Disabilities.Facilitate groups to provide education and support to member's and their families. Provided one on one counseling, when appropriate, to members on assigned caseload. Coordinate with co-workers to discuss ideas to better support members.
Work with children and adults in a foster care environment. Oversee all services provided to individuals and their families, monitor quality of care delivered, and ensure compliance with state regulations. Partner with foster parents and other internal resources to support transition needs for the consumers in the homes. As part of the treatment team, collaborate with many other professionals (Schools Administrators, Funding Sources, Therapists, Guardians, Parents). Serve in rotation (with Supervisor back-up) for After Hours Emergency On-Call response.