SUMMARY

The PACE Social Worker provides and coordinates a wide range of psychosocial services to participants and their families. Also responsible for providing community-based case management services for program participants.

PRIMARY FUNCTIONS
· Practices social work by establishing and maintaining a working relationship with participants.
· Maintain records and prepare reports
· Participates in Interdisciplinary team (IDT) initial assessment to determine services needed by the participant.
· Identifies warning signs, other problems, and sets measurable objectives
· Directs participant’s needs and visits with IDT attendance as per the Plan of Care.
· Monitors the quality and effectiveness of the services provided to a participant according to the individualized care plan.
· Documents all participant information in a timely manner, according to program standards and policies.
· Enters and updates all required information.
· Refers participants to appropriate community agencies or facilities and acts as a liaison with such organizations as advocate for participants.
· Attends and participates in IDT meetings; facilitates understanding of psychosocial aspects of care, and provides team with behaviorally stated psychosocial objectives.
· Consults and collaborates with other professionals to promote quality and continuity of participant care.
· Demonstrates respect for fellow professionals and IDT leadership.
· Demonstrates creative critical thinking in problem solving patient/family issues.
· Performs other duties and responsibilities as required.
· Attends staff meetings; in-service training; continuing education and workshops.
· Participates in Quality Assessment and Performance Improvement activities as directed.
· Assures completion of assessments in appropriate time frame.
· Initiates appropriate psychosocial case management based on established policy.

Maintains assessment and intervention documentation in a manner that reflects timeliness and completeness.
· Assist participants with care and transportation as assigned.
· Performs other duties as assigned by the manager.

QUALIFICATIONS
(EDUCATION and/or *EXPERIENCE)
· Master’s degree or above in Social Work (CSWE accredited) required.

· 3-5 years experience working in a case management capacity with at least 1 year experience working with the frail and elderly.
· Strong demonstrated capabilities in networking with community resources, and strong knowledge of such resources.
· Strong communication skills, including face-to-face, telephone, and computer skills.
· Strength in attention to detail and organization.
· Must be able to interact successfully with participants, families and other agencies to present a positive and professional image.
· Ability to manage multiple priorities simultaneously and effectively handle the emotional stress of the workload.
· Bi-lingual preferred.
· Ability to work unsupervised exercising a high degree of discretion & independent judgment.
· Ability to physically access any home, hospital, nursing home, and ALF i.e. navigate stairs, narrow stairs, narrow spaces, lack of air conditioning, etc.
· Ability to travel in community.
· Excellent telephone skills.
· Must have a valid driver's license, automobile insurance and reliable transportation.

CERTIFICATES, LICENSES, *REGISTRATIONS
Florida Driver's License and Auto Insurance, MSW

Job Type: Full-time

Job Type: Full-time

Benefits:

• 403(b)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Work Location: In person