Licensed Social Worker with hospital case management experience supporting complex discharge planning and transitions of care. Experienced in coordinating post-acute services, addressing barriers to care, and partnering with interdisciplinary healthcare teams to develop safe, patient-centered discharge plans. Passionate about improving care coordination and connecting patients to the right resources, whether in the hospital, post-acute settings, or their home communities.
Overview
10
10
years of professional experience
Work History
Social Worker
University of Chicago Medicine
Chicago, IL
11.2023 - 02.2026
Experience
Social worker, Adult Neurology
Managed care coordination and discharge planning for patients within the Comprehensive Stroke Center at University of Chicago Medicine.
Completed psychosocial and discharge planning assessments within 24 hours of admission to identify barriers to care and transition needs.
Collaborated closely with interdisciplinary teams including physicians, nursing, therapy, PM&R, palliative care, and utilization review to support safe and timely discharges.
Coordinated post-acute transitions to Acute Rehabilitation, Skilled Nursing Facilities, Long-Term Acute Care Hospitals, home health, outpatient services, dialysis, hospice, assisted living, and durable medical equipment providers.
Provided education to patients and families regarding post-acute care levels, community resources, insurance benefits, advance care planning, and discharge options.
Trained incoming staff on complex discharge planning for high-acuity stroke patients with significant medical, psychosocial, and placement barriers.
Participated in family meetings and goals-of-care discussions alongside Palliative Medicine and medical teams.
Assisted with utilization management activities including concurrent review, denial prevention, appeals, and peer-to-peer coordination with payer medical directors.
Monitored length of stay, avoidable days, and discharge barriers to improve patient throughput and reduce readmissions.
Assisted patients with completion of Advance Directives and Living Wills.
Developed extensive expertise in Acute Rehabilitation admissions criteria, insurance authorization processes, and identifying clinical barriers impacting rehabilitation acceptance and payer approval.
Lead in piloting UCM’s “Stroke to Home” screening program to identify patients appropriate for rehabilitation at home versus inpatient rehab, improving level-of-care decisions and post-acute resource utilization to decrease length of stay.
Delivered parent education and training to promote consistency, skill development, and carryover of therapeutic interventions in the home environment.
Social Worker
Rush Medical Center
Chicago, IL
08.2022 - 09.2023
Rush University Medical Center
Social Worker, Supportive Oncology
Managed an ambulatory oncology caseload for patients receiving outpatient treatment through the Cancer Center at Rush University Medical Center.
Conducted telephonic and in-person care coordination outreach to patients and caregivers referred for case management support.
Completed comprehensive biopsychosocial assessments to identify medical, psychosocial, financial, transportation, and community resource needs impacting treatment adherence and continuity of care.
Developed individualized care plans and psychosocial goals to support patients throughout the continuum of outpatient oncology care.
Provided education, supportive counseling, and resource navigation to patients and caregivers regarding treatment-related needs, insurance coverage, advance care planning, and community-based support services.
Coordinated referrals and linkage to community resources including financial assistance programs, transportation, home care services, behavioral health support, hospice, and supportive oncology resources.
Collaborated closely with interdisciplinary oncology teams, outpatient providers, and community agencies to address barriers to care and improve patient outcomes.
Assisted with ongoing care coordination and follow-up to support treatment compliance, symptom management, and reduction of avoidable hospital utilization.
Child Advocate Intern
WINGS
Chicago, IL
08.2021 - 05.2022
Child Advocate
Facilitated individual counseling sessions and age-appropriate support groups for children and families.
Conducted biopsychosocial assessments and developed intervention strategies based on identified client and family needs.
Maintained accurate clinical documentation, case notes, and progress reports.
Led parent support groups focused on strengthening parent-child relationships, communication, and goal setting.
Identified psychosocial risk and resilience factors impacting youth and family functioning.
Coordinated referrals and community resources to support case plan goals and ongoing family needs.
Collaborated with interdisciplinary clinical teams regarding treatment planning and case management needs.
Applied Behavior Analyst
Behavioral Analyst Inc
Davie, FL
05.2016 - 09.2018
Autism Therapist
Provided home-based and community Applied Behavior Analysis (ABA) services to children with developmental and behavioral needs.
Implemented individualized behavioral interventions focused on communication, social, emotional regulation, and functional living skills.
Utilized de-escalation and crisis intervention techniques to manage challenging behaviors and support client safety.
Collaborated with parents, caregivers, school psychologists, and ESE specialists to support treatment goals and reinforce behavioral strategies across settings.
Conducted behavioral observations, documented client progress, and participated in ongoing treatment planning and clinical supervision.
Delivered parent education and training to promote consistency, skill development, and carryover of therapeutic interventions in the home environment.
Grade 2 Social Worker (Subacute Rehabilitation) at Monash Health Kingston CentreGrade 2 Social Worker (Subacute Rehabilitation) at Monash Health Kingston Centre