Samantha Lugo

Served as the primary liaison between MultiCare and the Garden Villabe, coordinating complex admissions for high-needs patients, including those experiencing homelessness, mental illness, and substance use disorders. Secured state funding and appropriate insurance coverage to ensure seamless transitions from acute hospital care to long-term skilled nursing. I was able to leverage my social work expertise to develop and implement individualized discharge plans, including placement in supportive housing, arranging home health care, transportation, and other essential services to promote safe, stable transitions back into the community. Collaborated with state and local agencies, case managers, and families to navigate bureaucratic systems and advocate for patient needs.

• Independently managed and planned safe discharges for 40 patients within a nursing home. Mainly focusing on Medicare and VA insured patients this encompassed not only addressing their medical needs but also tending to their psychosocial well-being. I effectively coordinated logistics, communicated with healthcare professionals, and ensured a seamless transition back to daily living for each resident.

• Independently managed and planned safe discharges for 66 patients within a nursing home. This encompassed not only addressing their medical needs but also tending to their psychosocial well-being. Handling the entire process solo, I effectively coordinated logistics, communicated with healthcare professionals, and ensured a seamless transition for each resident.

• My role was to assist the Director in coordinating and planning a patients discharge from our nursing home. This involved collaborating with multidisciplinary teams, evaluating patients' needs, and developing comprehensive discharge plans to ensure a smooth transition and continuity of care.