
Nimble and collaborative Clinical Social Work Associate (CSWA) with a strong background in resource coordination, brief behavioral interventions, care coordination, and community engagement. Skilled in meeting people where they are and engaging in collaborative goal-setting. Known for building relationships with diverse community partners, colleagues, and patients to promote comprehensive care and improve patient outcomes in HIV care management.
Architected HIV-Specific Resource Specialist role.
Collaborates with multidisciplinary teams to coordinate comprehensive care for patients living with HIV and comorbid conditions. Including complex care coordination for acute needs.
Crisis intervention and brief behavioral/mental health assessments and interventions.
Assess for and address social drivers of health (SDOH), with an emphasis on knowledge of specialty resources available to people living with HIV.
Consultative resource for Legacy Health's inpatient Care Management team, ensuring patients living with HIV are engaged with follow up care, and discharged with HIV-specific resources.
Foster and maintain relationships with HIV-specific community partners such as Cascade Aids Project (CAP), CAREAssist, Quest Center, Central City Concern (CCC), and Multnomah County Health Department Disease Intervention Specialist (MCHD DIS).
Legacy Health's liaison to OHSU's Partnership Project.
Maintain Oregon Health Plan Certified Assister credentialing to assist patients in maintaining and enrolling in healthcare coverage.
Assist with enrollment and monthly renewal of CAREAssist benefits.
Utilized exceptional written and verbal communication across a diverse array of demographics to support patients, case managers, and providers across all Legacy hospitals in delivering quality discharge care coordination.
Built and maintained relationships and positive rapport with community partners and colleagues.
Adaptability in coordinating resources for urgent and changing discharge needs.
Collaborated with a multidisciplinary team to provide mental health support, behavioral interventions, community resource referrals, and behavioral health skills training for at-risk and marginalized adolescents and their families within a public high school setting.
Employed various techniques and modalities to fulfill individual and circumstantial needs such as collaborative problem solving, non-violent crisis intervention, and motivational interviewing.
Monitored client progress, documenting behavioral changes and participation in treatment sessions.
Architected HIV-Specific Resource Specialist role within Legacy Health to fulfill a gap in care in ambulatory care management. Ongoing engagement and care coordination to panel of 260+ patients to facilitate engagement in care, access to medications, SDOH resource allocation, mental health support, complex care coordination, and systems navigation; thus, resulting in better health outcomes for Legacy's patients living with HIV, which in turn positively impacts public health as a whole.
Clinical Social Work Associate, License #A18273
Certified OHP and Marketplace Assister, License #OHPP028
American Health Association BLS, exp. 2028