Licensed Clinical Social Worker - PACE Program

HEOPS•Benton, KY

15d

About The Position

LIFE COORDINATED is an integrated care company and PACE Program (Program of All Inclusive Care for the Elderly) operating in Kentucky. This is an important role that participates on the Interdisciplinary Team (IDT). We are seeking a Licensed Clinical Social Worker to join our team and work with elders with complex needs changing lives every day. We are passionate and purpose driven to be best-in-class. Our goal is to help our members live their best life based upon their personal goals. PACE allows us to invest in the right things to address root cause and environmental factors, not just symptoms and resulting medical care.

Requirements

Masters Degree
Licensed Clinical Social Worker or Licensure in Process
At least 1 year experience in a hospital, nursing home, or community-based services.
At least 1 year professional experience working with an elderly or frail population.
Demonstrated understanding of psychosocial problems of aging.
The ability to effectively work within an interdisciplinary team
The ability to work effectively with culturally, economically, and educationally diverse populations
The ability to form positive interpersonal relationships with a wide range of staff and clients.

Nice To Haves

At least 2 years’ experience, post-Masters education.
Demonstrated knowledge of mental health, especially in the elderly population.
Experience with and knowledge of various government support services and programs, especially Medicaid and Medicare.

Responsibilities

Serves as a member advocate and participates in the IDT (interdisciplinary care team).
Promotes and maintains the mental and social health of enrolled participants through assessment, treatment, education, and counseling.
Provides basic casework and consultation and facilitates communication between participants, their families, and the PACE program interdisciplinary team (IDT).
Maintains responsibility for the implementation of the social work care plan and coordination of social work with other services to optimize participant care.
Completes assessments at admission and for quarterly care planning according to regulatory requirements, and as condition change indicates.
Determines participant and family needs related to social support, financial support, counseling, and housing.
Confers with participant and family to identify participant goals and expectations.
Coordinates with the IDT to develop a comprehensive care plan for each participant.
Provides individual and group counseling to participants and their families as needed or as prescribed in the care plan.
Acts as a participant advocate and liaison between the participant, family, IDT, and Care Team by facilitating family meetings, the Participant Council, and/or family support groups, education, or training sessions.
Leads routine Family Caregiver meetings to provide education, support, and dialogue.
Coordinates the completion of the participant’s health care wishes and advance directives in cooperation with their primary care physician, the participant, and their family.
Provides discharge planning in the event of disenrollment.
Facilitates communication between the participant and various government programs such as Medicaid, SSI, Medicare, and Social Security.
Reviews Medicaid eligibility, monitors time frame for recertification and facilitates Medicaid applications for certification and recertification.
May participate in inter-agency meetings as needed.
Assists participants in obtaining housing and eligibility for low-income housing options.
Evaluates the need for and assists with the setup of money management systems for participants who require assistance.
Maintains current knowledge of changing rules and regulations regarding Medicaid and Medicare eligibility and other entitlement programs and services.