Social Worker

POSITION DESCRIPTION:

• Performs initial assessments of PACE participants to obtain a psychosocial history including cognitive status, mental health and substance use history, behavioral concerns, family dynamics, and current social supports.

• Participates within the interdisciplinary team in the formulation of Plans of Care, as well as in other interdisciplinary team settings that plan, coordinate and monitor the care of program participants.

• Conducts in-person reassessments of enrolled participants every six months or as determined by policy and best practice. Assessments include collaboration with caregivers and assessment of housing risk.

• Develops collaborative relationships with internal and external partners. Utilizes a solution-oriented perspective to facilitate resolution of participant needs.

• Acts as a primary liaison between the participant/family and the IDT to facilitate communication.

• Facilitates, mediates and documents participant care conferences, family meetings and facility partnership meetings.

• Monitors changes in the patient's condition and needs.

• Assists physician, or intermediate care provider, and other team members in understanding the significant social and emotional factors related to the health problems.

• Provides psychosocial services in accordance with established standards.

QUALIFICATIONS:

• Must have Master’s degree in Social Work from a school of social work accredited by the Council on Social Work Education

• Current CPR certification or the ability to obtain CPR certification is required.

• One year experience in a health care setting

• Experience conducting psychosocial assessments, care planning and case management skills required.

• A minimum of one year experience working with the frail or elderly.

• Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook.

• Ability to read, analyze and interpret regulations and other documents.

• Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.

• Ability to define problems, collects data, establish facts, and draw valid conclusions.

• Able to establish and maintain cooperative and positive working relationships