Social Worker - Westland

PACE Southeast Michigan•Westland, MI

13d

About The Position

The Master’s Social Worker (MSW) works independently to assess the needs of participants and their families or caregivers, and to coordinate and deliver social services. As a member of the Interdisciplinary Team (IDT), the MSW participates in assessing, intervening in, managing, and reviewing social service needs. Care is provided through modalities including bio-psychosocial assessment, cognitive behavioral interventions, psychoeducation, consultation, and care planning and case management. The MSW conducts comprehensive bio-psychosocial assessments at enrollment and every 180 days thereafter, along with acute assessments as needed to address specific referral questions. The role develops and implements individual treatment plans for participants and caregivers, provides counseling and education, coordinates services with the care team, performs risk assessment and crisis intervention, and directs case management. The MSW also supports care transitions and discharge planning, advocates for participants, collaborates with the IDT and families, documents services in the electronic health record, and evaluates progress toward care-plan goals.

Requirements

Master’s degree in social work from an accredited school of social work.
Licensed to practice in the State of Michigan; a limited license may be considered depending on experience and supervised hours.
One year of experience working as a clinical social worker.
Knowledge of case management skills, short-term interventions, and principles of human behavior.
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 ability to care for a diverse population.
Ability to learn and use an electronic health record system.
Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
Positive, flexible, and solution-focused attitude, with ability to collaborate effectively in a team setting.

Nice To Haves

Clinical social work experience in geriatrics is preferred.

Responsibilities

Conduct comprehensive bio-psychosocial assessments at enrollment and at 180-day intervals, and complete acute assessments as needed.
Use measurement-based care.
Develop and implement individual treatment plans for participants and caregivers, including counseling using Motivational Interviewing and CBT techniques, education, service coordination, and risk assessment or crisis intervention.
Direct case management for housing, financial, safety, psychiatric, and caregiver-burden issues.
Identify when a participant needs transfer to a higher level of care.
Assist with discharge-planning activities and processes.
Educate and counsel participants and caregivers about care needs, options, and related problems.
Advocate for participants and take accountability for resolving their concerns or issues.
Collaborate with the IDT, participants, and caregivers to develop and communicate impressions, plans of care, changes in care, and progress in a timely manner.
Help develop and implement the plan of care with the IDT, participant, and/or caregiver.
Complete timely and accurate documentation in the electronic health record.
Communicate participant changes with the IDT and family members.
Evaluate participant outcomes and progress toward care-plan objectives and goals, and communicate findings to the IDT.
Perform other related duties as assigned by leaders.