Danielle Alba
West Seneca,NY
Summary
Educated and dedicated to providing assistance to individuals and families in need. Proficient in assessing individual circumstances, identifying resources and developing plans of action to deliver support. Proven ability to work independently and collaboratively with diverse stakeholders. Compassionate with comprehensive knowledge of social service programs and community resources. Skilled at identifying needs and developing effective plans of action to provide intervention and assistance. Possesses strong organizational, interpersonal and communication skills. Highly motivated professional demonstrates ability to develop and implement successful plans of action to address individual needs. Possesses strong problem-solving skills to reduce barriers. Committed to helping individuals and families.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Behavioral Health Discharge Planner
Erie County Medical Center
Buffalo, NY
01.2014 - Current
- Coordinates between the treatment team (included Psychiatry, medical practitioners, social workers, nursing, legal departments, therapy departments, multiple outpatient and inpatient services located in the community) and the patient and families, surrogates, representatives to develop person centered, effective and cost-efficient discharge plan
- Work directly with adults on the inpatient behavioral health units
- Conduct initial interview and assessment to identify needs and barriers to developing safe discharge disposition for patient
- Develop strategies to address those barriers to discharge
- Oversees the education, referral and linkage process of patient and family to useful community services and support needed for transition from hospital
- This includes ensuring appropriate housing, outpatient follow ups, medical equipment, medications, legal/financial needs, and transportation
- Schedules and conducts individual and family meetings to discuss discharge planning progress
- Documents patient progress in treatment plans and notes in medical record in accordance with state regulations and hospital policy
- Participates in total quality improvement initiatives.
- Improved patient satisfaction by carefully evaluating their needs and developing personalized discharge plans.
- Advocated for patients'' best interests, working closely with healthcare providers to develop appropriate treatment plans and interventions.
- Coordinated timely discharges by effectively communicating with physicians, nurses, social workers, and other relevant stakeholders.
- Established strong relationships with community agencies, enabling effective coordination of post-discharge support services.
- Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
- Streamlined the discharge process, reducing wait times and increasing overall efficiency within the hospital.
- Facilitated smooth transfers between hospital departments, minimizing delays in patient care during transition periods.
- Served as a key resource for patients and families, providing guidance on post-discharge care options and resources.
- Coordinated travel arrangements and contacted family with travel information.
- Provided ongoing training and mentorship to new Discharge Planners, fostering a supportive team environment that promoted knowledge sharing and skill development.
- Managed complex cases involving multiple medical issues or psychosocial challenges by utilizing critical thinking skills and professional expertise in discharge planning processes.
- Evaluated patient progress throughout their hospital stay, adjusting discharge plans accordingly to ensure successful reintegration into the community setting or placement in suitable long-term care facilities when necessary.
- Promoted a patient-centered approach to discharge planning, incorporating individual preferences and needs into the development of tailored care plans.
- Facilitated timely referrals to alternate levels of care and assisted family or guardian with completion of applications.
- Supported patients in navigating complex healthcare systems by providing clear guidance on available resources and services postdischarge.
- Worked with utilization review to establish prior authorization for timely discharges.
- Collaborated with interdisciplinary teams to ensure seamless transitions from hospital to home or other care facilities.
- Ensured compliance with federal regulations and accreditation standards related to discharge planning activities within the organization.
- Communicated with referral providers about new referrals and verified receipt of necessary information prior to arrivals.
- Developed comprehensive education materials for patients, ensuring proper understanding of their conditions and necessary self-care techniques.
- Conducted regular reviews of case management processes to identify areas for improvement and implement targeted interventions.
- Enhanced patient outcomes through thorough follow-up assessments and adjustments of discharge plans as needed.
- Participated in continuous improvement initiatives aimed at enhancing the efficiency and effectiveness of the discharge planning department.
- Implemented evidence-based practices to optimize the quality of discharge planning services provided to patients.
- Assisted patients in accessing financial assistance programs, helping to alleviate the burden of medical expenses during their transition from hospital care.
- Maintained detailed records of patient progress, documentation of services and case notes.
- Coordinated patient discharge planning and follow-up care.
- Assisted patients in accessing housing, financial assistance and other community resources.
- Managed caseload to satisfy multiple patients with diverse needs.
- Provided patient and family education on available resources and self-care strategies.
- Coordinated individualized discharge plans to manage safe transition back into community and home environments.
- Facilitated family meetings to discuss patient care plans.
- Updated treatment plans on monthly basis with latest intervention strategies and progress notes.
- Worked with medical teams, patients and families to implement effective treatment plans.
- Facilitated support groups for patients and families dealing with chronic illnesses.
- Collaborated with healthcare providers to drive continuity of care.
- Conducted in-home visits to provide supportive services.
- Assessed risk factors of patients and made referrals for further services.
- Participated in clinical supervision to maintain professional development.
- Preserved and prepared reports and treatment records.
- Participated in interdisciplinary care conferences to discuss patient care plans and referrals.
- Developed individual treatment plans and provided counseling to patients.
- Developed partnerships with community organizations to expand services and referrals.
- Completed psychosocial evaluations and needs assessments.
- Provided crisis intervention services to individuals facing medical, emotional and mental health challenges in hospital setting.
Rehabilitation Counselor II
Lake Shore Behavioral Health
01.2007 - 01.2014
- Provided individual and group services to adults with mental health and/or substance abuse diagnoses
- Assisted individuals in resuming life roles in employment, work, housing and social domains
- Conducted routine psychological assessments and individualized treatment planning
- Helped individuals identify personal strengths and assists in overcoming challenges/barriers related to mental health and/or substance abuse diagnoses
- Provided pre-admission screening to new clients to assess appropriateness for services
- Provided case management service to assist with linkage to community and social services
- Functioned as a member of a multi discipline team
- Responsible for documenting client progress in individual and monthly notes
- Maintained medical and paper record in accordance with state requirements and agency best practices.
Residential Director
Baker Victory Services
01.2007 - 01.2008
- Supervised and trained four mid-level management staff and ten entry level managers
- Provided oversight for eight OMRDD Individual Residential Alternatives serving 50 consumers
- Recruited, interviewed and hired potential management candidates
- Ensured all programs ran in compliance with New York State OMRDD rules and regulations
- Took lead role in Bureau of Certification surveys; wrote and implemented POCA
- Facilitated positive relationships among individuals served, families, advocates and the Agency.
Behavior Management Coordinator, Team Coordinator
Aspire of WNY
01.2002 - 01.2007
- Created behavior plans or protocols tailored to meet individual treatment needs
- Trained direct care professionals on application of behavior program or protocol
- Monitored, collected and analyzed data to measure success of programs
- Ensured least restrictive methods of behavior modification were being utilized
- Ensured all consents for psychotropic medications or restrictions were obtained
- Presented individual cases to behavior management committee, risk management or individual rights committee
- Provided oversight for one OMRDD Individual Residential Alternative serving seven behaviorally challenged individuals
- Supervised and trained ten direct care professionals
- Interviewed, hired and scheduled direct care professionals assigned to site
- Wrote, implemented and monitored Res- Hab.Plans and Individual Plans of Protective Oversight
- Managed consumer bank accounts and household money
- Provided 24/7 on-call coverage for site.
Education
Master's in Healthcare Administration -
Excelsior University
Bachelor of Arts in Psychology -
Daemen University
Masters Social Work -
Keuka College
01.2026
Skills
- HIPAA Compliance
- Healthcare systems navigation
- Patient support
- Medication Reconciliation
- Community Resources
- Care Coordination
- Quality Improvement
- Treatment Plans
- Ethical considerations
- Interdisciplinary Collaboration
- Problem-Solving
- Excellent Communication
Certification
- Mindfulness for Stress Reduction
- Certified Cognitive Enhancement Therapy Coach
- Dialectical Behavioral Skill Training
- FIT- Focus on Integrated Treatment
- Suicide assist training
Committeesandmemberships
- Ethics committee at Erie County Medical Center
- Community Partnerships at Erie County Medical Center
Additional Information
Trained in teaching or performing:
Mindfulness for Stress Reduction
Certified Cognitive Enhancement Therapy Coach
Dialectical Behavioral Skill Training
FIT- Focus on Integrated Treatment
Suicide assist training
Timeline
Behavioral Health Discharge Planner
Erie County Medical Center
01.2014 - Current
Rehabilitation Counselor II
Lake Shore Behavioral Health
01.2007 - 01.2014
Residential Director
Baker Victory Services
01.2007 - 01.2008
Behavior Management Coordinator, Team Coordinator
Aspire of WNY
01.2002 - 01.2007
Master's in Healthcare Administration -
Excelsior University
Bachelor of Arts in Psychology -
Daemen University
Masters Social Work -
Keuka College