Empathetic bilingual Medical Social Worker with over 4 years of experience interfacing with community liaisons, facilitating individual and group sessions and monitoring conditions of clients to coordinate care. Excellent communicator with knack for building lasting professional relationships.
Overview
5
5
years of professional experience
Work History
Medical Social Worker (all Units)
Providence, St. Mary Medical Center
02.2022 - Current
Manages approximately 10 to 15 patient consults, incoming calls, emails and faxes per day from other healthcare facilities, Children Family services, and Adult Protective Services.
Assessed risk factors of patients and made referrals for further services.
Organized clinical documentation, treatment plans, and referrals.
Developed partnerships with community organizations to expand services and referrals.
Provided ongoing counseling to help patients deal with conditions and processes
Conducts initial assessment (social, emotional, and financial needs of patients/families), planning, implementation (guidance/resources), coordination (placement), on-going monitoring, and evaluation of plan of care (discharge)
Identifies and participates in problem-solving issues that could be discharge barriers from psychosocial perspective
Provides crisis intervention, and initiates referrals to appropriate resources to ensure patient/family psychosocial and emotional needs are addressed
Identifies and records clinical, psychosocial, and financial barriers for smooth transition across healthcare continuum and assists in identifying and facilitating system improvements
Works with leadership to identify problems, recommend solutions and work toward resolution
Identifies need for and conducts family meetings and/or interdisciplinary team conferences to resolve issues and ensure treatment/discharge plan progresses
Manages issues such as guardianship, abuse/neglect, adoption, power of attorney, healthcare advocacy, surrogacy, and advanced directives
Serves as resource to hospital staff and physicians regarding emotional, social, and psychosocial components of patient illnesses
Ensures integration of interdisciplinary team in understanding and integrating these aspects into care plan
Documents activities with entries (EPIC) in patient's clinical record that is consistent with hospital requirements, licensure, and regulatory guidelines
Supports interdisciplinary team conferences and contributes to planning and review of care for patients presented as needed.
Worked with medical teams, patients and families to implement effective treatment plans.
Supported ethical decision-making processes among healthcare teams by providing guidance on complex cases involving end-of-life care or medical ethics dilemmas.
Promoted effective communication between patients, families, and medical staff through skilled mediation techniques during challenging conversations.
Provided emotional support to patients and families during critical health situations, promoting coping mechanisms and resilience.
Coordinated individualized discharge plans to manage safe transition back into community and home environments.
Collaborated with healthcare providers to drive continuity of care.
Completed psychosocial evaluations and needs assessments.
Participated in clinical supervision to maintain professional development.
Maintained detailed documentation of client progress, adhering to strict confidentiality guidelines in compliance with HIPAA regulations.
Connected patients with community resources, ensuring access to essential services such as housing, healthcare, and financial assistance.
Participated in interdisciplinary care conferences to discuss patient care plans and referrals.
Provided patient and family education on available resources and self-care strategies.
Documented case notes daily and coordinated follow-up for seamless case management.
Coordinated patient discharge planning and follow-up care.
Facilitated family meetings to discuss patient care plans.
Ensured continuity of care by coordinating seamless transitions from hospitalization to outpatient services or long-term care facilities.
Healthcare Social Worker
Tender Heart Adult Day Health Care Center
05.2019 - 02.2022
Provided up to 50 clients with case management services
Registered Nurse, Emergency Department at Providence St. Mary Medical CenterRegistered Nurse, Emergency Department at Providence St. Mary Medical Center