Monserrat Martinez

• Assisted clients in navigating healthcare resources and services effectively.
• Coordinated care plans with multidisciplinary teams to enhance patient support.
• Provides short term, virtual case management for veterans, service members, and their families.
• Monitor virtual caseloads and provides relevant resources/connections.
• Receive inbound calls, perform outbound calls, respond to voicemails and emails from military veterans, service members, and their families.
• Conducts SDOH assessments and additional screenings such as psychosocial risk factors, suicide risk, and baseline mental health assessments.
• Coordinate with public and private sector implementation partners (ACMF, AZDVS, and any other partners that may join in the future); coordinate service provision by peer support providers (VA and community-based)
• Participates in weekly case review process with internal and external stakeholders.
• Provides resources and tools to client to strengthen independent living skills.
• Documents calls and interactions effectively prior to the end of their scheduled shift in designated EHR systems.
• Assists in coordinating transportation related services and other basic needs for veterans and their families.
• Weekly submission of success stories with community members.
• All other duties as assigned.

• Provide real time support to the floor by ensuring program specialists are adhering to 211 program
procedures and best practices.
• Consistently be available and responsive to the program specialists’ needs.
• Supports staff with handling escalated calls and informing 211 supervisor(s) when
necessary.
• Works in partnership with program operations and leadership to improve overall efficacy and team performance by providing coaching, feedback, support, and training to improve individual and team
performance and well-being.

• Trained new employees on operational procedures and best practices for enhanced performance.
• Coordinated team schedules to optimize workflow efficiency and resource allocation.

Program specialist I
• Provide phone-based high-quality confidential information, referral, and advocacy for health and social
services.
• Document unmet needs to assist in the identification of gaps in services that can be addressed through
2-1-1 data reporting.
• Accurately document all customer interactions using web-based computer software systems.
• Demonstrates an understanding of social services and community resources in Arizona

Program specialist III

• Responsible for receiving, responding to, and triaging urgent SDOH issues and healthcare requests

• Screens and triages incoming requests

• completes an assessment and intervention

• Provided advocacy for housing

• mental health, mandate reports for APS/DCS, Missing or Murdered Indigenous People (MMIP).

• Connect families experiencing homelessness to emergency shelter
• Provide families with community resources or basic needs while waiting for shelter
• Brainstorm with families to create housing plans to obtain permanent housing
• Use trauma informed care to address family needs

• Analyzed data trends to support decision-making and optimize resource allocation.
• Developed and implemented process improvements to enhance operational efficiency.
• Collaborated with cross-functional teams to align project goals and deliverables.

• Provided support to families by facilitating communication and understanding of child development needs.
• Developed individualized care plans in collaboration with families to address specific challenges.
• Coordinated resources and referrals for families to access essential services and support systems.
• Conducted regular assessments to monitor family progress and adjust interventions as needed.
• • Coordinated and supervised court ordered visits for Department of Children Safety (DCS).
  • Transported children to coordinated visits.
  • Documented all interactions between parents & children and submitted summaries to DCS.
  • Track expenses & mileage for reimbursement.

• Developed engaging educational activities for diverse youth populations.
• Coordinated daily schedules and ensured smooth program operations.
• Implemented age-appropriate developmental assessments to track progress.
• Facilitated conflict resolution among participants, promoting a positive environment.
• Provided quality care and supervision for children in a structured Child Development Center on military installations.
• Developed and implemented age-appropriate learning and recreational activities supporting children’s emotional, social, and cognitive development.
• Maintained a safe, positive, and inclusive environment in alignment with CDC and Department of Defense policies.
• Communicated regularly with parents and staff to support each child’s individual needs and progress.
• Monitored classroom ratios, ensured compliance with all safety and program standards, and maintained accurate attendance and incident reports.