Social Worker MSW

INNOVATIVE INTEGRATED HEALTH•Fresno, CA

2d•$33 - $38

About The Position

The Social Worker MSW is responsible for direct social work case management services to participants and works collaboratively with the PACE Interdisciplinary Team (IDT) to manage long-term care needs.

Requirements

Interest in the risk-based long-term care program to serve frail elderly in a community-based setting.
Experience and thorough knowledge of social service principles and practices.
Knowledge of psychosocial, behavioral, and family needs of the elderly population.
Knowledge of the local and social service delivery systems and aging network.
Proven ability to work in an interdisciplinary team.
Ability to work effectively and harmoniously with the staff, the elderly, and providers of services, public, and private agencies.
Energetic, dependable, resourceful, and flexible.
Effective oral and written communication skills.
Computer skills required.
Minimum of one (1) year of documented experience in working with the frail or elderly population.
Master’s degree in social work from an accredited school of social work.
Is medically cleared for communicable diseases and has all immunizations up to date before engaging in direct participant contact.

Nice To Haves

Preferred experience in a community-based setting or geriatric program.
Preferred experience in substance abuse counseling.
Preferred experience in working with the homeless population.

Responsibilities

Participate as a member of the interdisciplinary team (IDT), conduct initial, semi-annual, unscheduled, and annual assessments; attend morning updates and report changes in participants’ baseline status to appropriate staff on a daily basis.
Familiar with the California Adult Protective Services (APS) mandated reporting requirements and guidelines.
Provide education regarding Durable Power of Attorney, Advance Health Care Directive
Deliver psychoeducation regarding depression, assessment, and cognitive assessment results to participants and their family members.
Involved in the development and implementation of Quality Improvement (QI) activities.
In conjunction with the interdisciplinary team (IDT), may conduct the initial intake, meeting with family members and others.
Coordinate ongoing family meetings, as needed.
Obtain biopsychosocial history from participant and/or family members upon admission to the program.
Provide individual and family counseling as needed or prescribed in the plan of care; develop and lead group counseling and support activities.
Provide crisis intervention and advocacy as required.
In conjunction with the IDT, coordinate discharge planning for participants returning home from hospital or nursing facility.
Maintain current, written case management records, including ongoing documentation of services provided, reassessment of changing needs and participant’s expressed wishes.
Act as liaison between the participant and other agencies such as Department of Aging, Social Security Administration, Medicaid, etc.
May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver’s License is required.
Provide resources and referrals to assist with financial management.
Assist with ongoing financial eligibility for participants, including recertification as needed.
Participate in participant-related conferences in the community as designated.
Maintain confidentiality of participant information.
Attend and participate in staff meetings, in-services, projects, and committees assigned.
Adhere to and support the company’s practices, procedures, and policies including assigned break times and attendance.
Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
Be flexible in the schedule of hours worked.