Position Title: Social Worker, Lead (Licensed Master’s Social Worker)

Reports To: Social Work Manager

POSITION SUMMARY:

Under the leadership of the Social Work Manager, the Lead Social Worker (Licensed Master’s

Social Worker) (LMSW) works independently to assess the needs of, coordinate, and deliver

social services for participants and families/caregivers. The LMSW is a member of the

Participant Care Team (PCT) and the Interdisciplinary Team (IDT) and participates in the

assessment, intervention, management, and review of social service needs. The LMSW also

assists the IDT in determining eligibility and care needs. The LMSW provides care through a

variety of modalities, including but not limited to, bio-psychosocial assessment, interventions

that include individual and group counseling utilizing motivational interviewing, and cognitive

behavioral techniques, psychoeducation, consultation, and care planning/case management.

Additionally, the Lead Social Worker is responsible for daily clinical management, supervision,

and oversight of social workers.

SPECIFIC DUTIES AND FUNCTIONS:

Lead

• In addition to carrying a full social work caseload and being responsible for associated roles
  
  
  

and responsibilities (see below), the Lead Social Worker is responsible for the daily clinical

management, supervision, and oversight of social workers.

• Under the leadership of the Social Work Manager, the Lead Social Worker provides direct
  
  
  

oversight at their respective center.

• Lead Social Workers, in conjunction with the Social Work Manager, form the Social Work
  
  
  

Leadership Council, which formulates and monitors departmental goals and outcomes and

revises strategy based on performance outcomes.

• Ensures social work staff are effectively participating on the Participant Care Team (PCT)
  
  
  

and Interdisciplinary Team (IDT) for participant care and coordination.

• Partners with the Center Manager and the Social Work Manager to ensure effective
  
  
  

operations and PCT and IDT participation.

• Provides clinical supervision to limited licensed social workers and interns employed at
  
  
  

PACE Southeast Michigan and ensures professional development and continuing education

for all social workers employed at the Lead’s respective center.

• Represents the department on various process/quality improvement projects, initiatives,
  
  
  

and committees.

• Ensures compliance to departmental and organizational standards and all state and federal
  
  
  

regulatory requirements.

• Routinely audits social work care plans, assessments, progress notes, Level of Care
  
  
  

Determination (LOCD) paperwork, and disenrollment paperwork. Ensures accurate,

clinically appropriate, and timely completion of documentation.

• Performs other related duties, as assigned by leader(s).
  
  
  

Licensed Master’s Social Worker

• The LMSW is a member of the PCT and IDT and performs a comprehensive biopsychosocial assessments upon enrollment and at 6 and 12 month intervals thereafter.
  
  
  

Acute assessments are completed on an as-needed basis and aim to answer specific referral

questions. Utilizes measurement-based care.

• Develops and implements appropriate, individual treatment plans for both Participants and
  
  
  

caregivers, including but not limited to:

• Individual and/or group counseling (utilizing Motivational Interviewing and CBT
  
  
  

techniques)

• Education
• Consultation services to the Care Team
• Risk Assessment/Crisis Intervention
• Directs case management Issues, including but not limited to:
• Housing Issues
• Financial Issues
• Safety Issues including, but not limited to: symptoms of abuse, neglect or
  
  
  

exploitation; ability to live independently; decision-making capacity; any other issues

warranting involvement of Adult Protective Services (APS)

• Psychiatric: Changes in mood, behavior, cognition/mental status; suicidal/homicidal
  
  
  

ideation; substance use/misuse

• Caregiver Burden
• Identifies the need to transfer to a higher level of care (e.g., Behavioral Health
  
  
  

Services).

• Assists in coordinating discharge planning activities and processes.
• Assists in coordinating 24-hour care as indicated by interdisciplinary team and/or
  
  
  

the Care Team.

• Educates and counsels the participant and/or caregiver regarding care needs,
  
  
  

options and other related problems.

• Advocates to others on behalf of the participant, and demonstrates accountability in
  
  
  

resolving participant concerns or issues.

• Works collaboratively to develop and communicate initial impressions, plans of care,
  
  
  

changes in care, and progress in a timely fashion.

• Helps to develop and complete the plan of care with the IDT, participant, and/or
  
  
  

caregiver.

• Completes timely and accurate documentation in the electronic health record (EHR).
• Communicates changes in participants with IDT and family members.
• Evaluates participant outcomes and or progress toward achieving the objectives and goals
  
  
  

of the care plan and communicates this information among other members of the PCT and

IDT.

• Performs other related duties, as assigned by leader(s).
  
  
  

QUALIFICATIONS (knowledge, skills, abilities):

• Master’s Social Worker from an accredited school of social work.
• Licensed to practice in the State of Michigan. LMSW required.
• Three years' experience working as a clinical social worker, preferably in the field of
  
  
  

geriatrics. Knowledge of the principles of human behavior, individual and group therapy

techniques (preferably CBT and DBT), short-term interventions, and substance use

disorder assessment and treatment.

• One year experience in supervision/management/leadership. May be substituted by
  
  
  

Other Demonstration Of Leadership Potential And/or Abilities.

• Skilled facilitator and problem solver with excellent communication and interpersonal
  
  
  

skills.

• Demonstrated knowledge and skill in evaluating, planning, implementing, and
  
  
  

monitoring patient-centered approaches to care.

• Knowledge of and compliance with applicable local, state, and federal laws and
  
  
  

regulations.

• Cultural competence and an ability to care for a diverse population.
• Ability to learn and use electronic health record system. Auditing experience preferred.
• Proficient in Microsoft Word, Excel, Outlook, PowerPoint.
• Positive, flexible, and solution-focused attitude with ability to collaborate effectively in a
  
  
  

team setting.