Conduct and document detailed psycho-social assessments to interpret the social, environmental, and medical needs of the patient. Serves as a liaison with the community resources and their staff to facilitate smooth transition and placement of patients. Provides or supervises plan of care interventions to include resource and referral assistance, crisis intervention, prevention, education, patient advocacy, bereavement, therapy, and counseling as appropriate. Collaborates with the healthcare team and involves the patient and family in the development and implementation of plans

Supportive and Palliative Care DepartmentWorked with inpatient patients and families by providing individual counseling, grief support, support adjusting to the hospital setting or their illness prognosis. Worked in outpatient clinic educating, resource connection in the community or the hospital for patients and their families.

Known as: Medilodge of LivingstonCase management of short-term physical rehabilitation, long-term medical/dementia care, ventilator-dependent units. Facilitated connection to resources or services both within and outside of the facility. Performed intakes, assessments and screenings for community resources, discharge planning. Lead interdisciplinary care planning and behavior modification meetings. Prepared documents and attended court hearings for guardianship, conservatorship as well as involuntary hospitalization and discharges.

Formerly known as Westland Nursing and Rehab CenterCase management of short-term physical rehabilitation, long-term medical/dementia care. Facilitated connection to resources or services both within and outside of the facility. Performed intakes, assessments and screenings for community resources, discharge planning. Lead interdisciplinary care planning and behavior modification meetings. Prepared documents and attended court hearings for guardianship, conservatorship as well as involuntary hospitalization and discharges.

Known as: Heritage Manor Nursing and Rehab CenterCase management of short-term physical rehabilitation, long-term medical/dementia care. Facilitated connection to resources or services both within and outside of the facility. Performed intakes, assessments and screenings for community resources, discharge planning. Participated in interdisciplinary care planning and behavior modification meetings. Prepared documents and attended court hearings for guardianship, conservatorship as well as involuntary hospitalization and discharges.