Experienced Licensed Clinical Social Worker with extensive background in both the Acute Care and Outpatient settings. I am confident in conducting comprehensive psychosocial assessments and facilitating safe discharges to the most appropriate level of care. Skilled in crisis intervention and familiar with community resources, I excel in coordinating care for complex cases, ensuring optimal patient transitions and specializing in lowering the geometric length of stay in multiple healthcare facilities. Proficient in a variety of assessment modalities, and prepared for complex clinical needs for patients and their families.
Conduct full psychosocial assessments relating to veterans who are followed by Nephrology and/or Oncology teams in the outpatient setting.
Facilitate and manage discharges in the acute care setting for all veterans on dialysis (in-center, peritoneal dialysis, or home hemodialysis)
Complete full Social Services assessments for Veterans preparing for Kidney or Stem Cell Transplants.
Participate on multiple committees such as VISN 21 Dialysis Committee, Cancer Care Navigation Committee for Northern California.
Collaborate with Leadership and Intradisciplinary team meetings to assess and intervene in complex cases, creating positive movement in avoiding significant lengths of stay for Veterans.
Responsible for contributing to Veteran's Electronic Medical Record in professional and accurate documentation.
Participate in the multidisciplinary team to assess, create, and execute safe discharge plans for patients and families.
Complete psychosocial assessment for patients in the Emergency Department, Intensive Care Units, Labor and Delivery, Med-Surg Units, and Outpatient Surgery Departments.
Coordinate and collaborate with outside facilities and agencies (Skilled Nursing Facilities, Hospice Agencies, Home Health Agencies, Board and Cares, Homeless Shelters, Dialysis Centers, VA programs, to ensure patients transition to a lower level of care safely and appropriately.
Responsible for the SB1152 Homeless Discharge Planning implementation of policies, logs, and California Hospital Association meetings
Responsible for case managing Geometric Length of Stay/ Complex Cases
Responsible for reporting all suspected abuse and neglect to various agencies thoroughly and punctually.
Certified and trained in facilitating Crisis Incident Stress Debriefings for staff after large events.
Responsible for contributing to patients Electronic Medical Record in professional and accurate documentation.
Suicide Risk Assessments (CSSRS)
Depression Screenings (PHQ-9)
Social Determinants for Health Assessments (SDOH)
Psychosocial Assessments for drug exposed newborns & mothers
DSM-V knowledge
Placement needs and services
Community referrals and outreach
Referrals to SNF, Hospice, Home Health, Outpatient Dialysis, ALS and BLS transfers, Assisted Living Waiver Program, and Durable Medical Equipment
Knowledgeable in Medi-Cal services, managed Medicare/Medi-Cal insurances, and private insurances
Recognized as the 2020 Tenet Hero after supporting patients and families in Intensive Care Unit during the COVID-19 Pandemic.
Received Better Together Award 2024, VA Northern California
Master of Social Work Student Association, Vice President 2016-2017
Licensed Clinical Social Worker, LCSW- Issued: 3/31/2021, Valid until 3/31/2027