Proficient in performing comprehensive medical, psychosocial, emotional, financial, and mental health assessments to develop a tailored discharge plan.
Experienced in identifying potential barriers that could impede a seamless, timely and safe discharge to reduce hospital readmissions.
Actively participated in daily interdisciplinary care team rounds to ensure effective communication and collaboration.
Compiled lists of community, financial, medical, and mental health resources based on needs and insurance status.
Successfully discharged patients to skilled nursing facilities, assisted living communities, acute rehabilitation, long-term acute care hospitals, and hospice facilities.
Proficient in facilitating appropriate durable medical equipment.
Recognized for meticulous documentation, problem solving and organizational skills, dedication to patients and families, and a team player.
Dedicated to practicing according to the social work ethics and standards.