MICHELE REECE
Milton-Freewater,OR
Summary
Compassionate and empathetic candidate with experience working in skilled nursing and rehabilitation facilities. Experienced discharge planner and patient resource advocate.
Experienced with managing social service programs, ensuring effective service delivery to diverse populations. Utilizes strong leadership and program development skills to drive impactful community initiatives. Track record of fostering collaborative team environments and achieving positive outcomes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Social Services Director
Evergreen Healthcare Group
Milton-Freewater, OR
05.2017 - Current
- Fostering and encouraging a work environment of open, honest communication.
- Developing relationships with residents, and advocating for their needs.
- Providing support to my fellow Interdisciplinary Team as needed.
- Daily progress notes for alert charting, updated communication with family, and any resident-centric information.
- Advocating for residents and their rights, and working closely with the Ombudsman when needed.
- Providing residents and families support during a difficult time, informing them of all the options for the situation, educating on topics if needed, and then allowing them to make an informed decision. Together, we work towards the goal they have established.
- Participating in daily clinical meetings.
- Create, maintain, and update a comprehensive person-centered care plan.
- All aspects of safe discharge planning start on the day of admission.
- Oversee and complete the discharge process, including post-discharge services, support, DME, and referrals for additional home safety.
- Sending all required monthly Transfer/Discharge Notices to the Oregon State Ombudsman.
- Organized and led care conferences with families, community support, interdisciplinary teams, and therapies. Frequency: admission, quarterly, and discharge.
- Completed quarterly evaluations on all residents.
- Worked with difficult family dynamics to come to a common goal for the resident.
- Created and maintained solid relationships with my IDT, state case managers, hospital case managers, DME suppliers, and home health services.
- Organized and ran monthly psychotropic meetings with the IDT and pharmacist.
- Complete the MDS sections for clinical reimbursement.
- Look at perspective admissions for care center appropriateness regarding behaviors, psychotropic medications, discharge plan, community support, and funding.
- Implemented virtual mental health into MFHR using encounter telehealth.
- Helping residents obtain funding services such as Medicaid, SSDI, and SSI.
- Helping residents find and obtain affordable, appropriate living accommodations.
- Implementing and executing training for mental illness and dementia behaviors utilizing non-pharmacological interventions.
- Creating in-services to train staff on new CMS guidelines as they roll out.
- Implement behavior care plans and staff behavior charting. Analyze data collected to continue to develop a comprehensive mental health care plan and integrate services, non-pharmacological interventions, and psychotropic medication interventions as needed.
- Make hospice referrals.
- Helping residents complete advance directives.
Social Services, MSW
Washington Odd Fellows Home
Walla Walla, WA
07.2015 - 03.2017
- Consulted with residents, family, and care team to develop treatment plan goals and objectives. Reassess and adjust as appropriate
- Counseled residents and families to help them understand and overcome personal, social and behavioral problems
- Advocate for rehabilitation patients and long-term care residents to provide a improved quality of life and resolve crises
- Hospice referral and coordination for both in facility and home discharge end of life care
- Refer patients or family to community resources to assist in recovery such as; home health or outpatient therapy, nursing, medical supplies, meal assistance, caregiving, transportation, financial assistance, etc.
- Complete Medicaid and Medicare related paperwork and record keeping in skilled nursing /rehabilitation facility
- Supervise and direct other workers providing services to residents
- Monitor, evaluate, and record patient progress according to measurable goals described in treatment and care plan
- Modify treatment plans to comply with changes in patients' status. Plan discharge from care facility to home or other care facility
- Provide thorough daily progress notes and daily documentation
- Work closely with therapy team to coordinate discharges and community resources recommended upon return to independent living or lesser care environment
- Complete all discharge paperwork including making all referrals to community resources recommended upon discharge
- Coordinate and attend all family care meetings
BSW and MSW Social Services Intern
Park Manor Rehabilitation Center
Walla Walla, WA
09.2013 - 07.2015
- Completed intake and psychological assessments
- Completed Medicare/Medicaid assessments and documentation
- Completed discharge surveys
- Organized care conferences
- Addressed resident, family, and staff concerns
- Completed required Medicare/Medicaid training
- Attended all staff meetings
Education
Master of Social Work - Social Work
Walla Walla University
College Place, WA07-2015
Bachelor Social Work - Social Work
Walla Walla University
College Place, WA06-2014
Skills
- Excellent communication and problem resolution skills
- Develop, implement, and reassess care plan as needed
- Previous experience with care team coordination for wrap around approach
- Experienced in Dementia care
- Experience coordinating with therapy team on rehabilitation and discharge goals
- Experienced discharge planner
- Experience in Medicare/Medicaid certified facilities
- Complete psychosocial assessment to identify areas of need and address them accordingly
- Knowledge of psychoactive medications and treatments and experience in non-pharmaceutical intervention treatment planning
- Ability to maintain required documentation for clinical records
Certification
- Basic Life Saving Support (BLS)
- Mental Health First Aid
- Suicide Assessment, Treatment, and Management
Timeline
Social Services Director
Evergreen Healthcare Group
05.2017 - Current
Social Services, MSW
Washington Odd Fellows Home
07.2015 - 03.2017
BSW and MSW Social Services Intern
Park Manor Rehabilitation Center
09.2013 - 07.2015
Master of Social Work - Social Work
Walla Walla University
Bachelor Social Work - Social Work
Walla Walla University