PACE Social Worker

Volunteers of America National Services (VOANS)•Montrose, CO

2d•$70,000 - $110,000•Onsite

About The Position

Senior Community Care of Colorado PACE is hiring a Social Worker in Eckert, Colorado. The role assesses participant and family needs, identifies effective social-service interventions, and coordinates with the Interdisciplinary Team (IDT), Behavioral Health Specialist, Chaplain, contracted providers, and others to implement plans of care and provide psychosocial interventions. The Social Worker also serves as an educational resource for the PACE team and supports high-quality, person-centered care. The position provides social work services to older adults and their families, including initial enrollment assessments, periodic and as-needed reassessments, care planning, counseling and education, placement coordination, advocacy, referrals, and support related to hospice and end-of-life needs. The Social Worker documents clinical services and significant participant events, supports grievances and quality improvement, follows organizational and safety policies, and maintains confidentiality and professional certifications. The schedule is Monday through Friday, 8 a.m. to 5 p.m. The listed annual salary ranges are $70,000–$89,000 for an MSW pursuing licensure, CSW, or LSW, and $90,000–$110,000 for an LCSW. Relocation assistance is offered. The program provides healthcare and supportive services to people age 55 and older to help them live safely and independently in their homes and communities.

Requirements

Master’s degree in social work from an accredited school.
Be legally authorized and currently licensed, registered, or certified as a SW-C or LSW in Colorado, or be licensed as an LCSW in Colorado.
Current Cardiopulmonary Resuscitation (CPR) certification.
Valid driver’s license, proof of insurance, and access to transportation.
At least one year of experience working with a frail or elderly population.

Nice To Haves

Experience working on a multidisciplinary team in a hospital, nursing home, or community-based setting.

Responsibilities

Conduct in-person initial psychosocial assessments for prospective participants, including assessment of cognitive status, social supports, family dynamics, mental health, substance dependency, needs, and other relevant issues.
Coordinate with the Interdisciplinary Team to develop a comprehensive plan of care for each participant.
Conduct in-person reassessments every six months and as needed.
Participate in Interdisciplinary Team meetings, communicate participant changes, collaborate on care-plan decisions, and coordinate 24-hour care delivery.
Provide participants and families with ongoing support, counseling, and education on aging, dementia, grief and loss, end of life, disease processes, family dynamics, changing roles, the PACE model, and PACE health services.
Present requests to the Interdisciplinary Team and coordinate admission to and discharge from contracted facilities for respite or permanent placement.
Facilitate meetings with participants, families, caregivers, and community agencies to clarify or resolve care-plan issues and mediate discussions.
When hospice care is appropriate, provide emotional support, grief support, education, and referrals for funeral or financial planning; facilitate hospice or nursing-home placement as needed.
Refer participants to external community resources, such as Adult Protective Services, housing authorities, and public utility companies, and advocate to support community stability.
Assist participants and caregivers with Medical Durable Power of Attorney proxies and Do Not Resuscitate directives.
Attend and participate in organizational meetings related to participant care, including morning, intake and assessment, in-service, and community-agency meetings.
Serve as a resource to team members and day-center staff on dementia, difficult behaviors, and difficult personalities.
Complete and ensure completion of clinical documentation in participant medical records, including assessments, changes in status, placements, hospital admissions and discharges, visits, and other significant events, according to documentation requirements.
Assist participants and caregivers in filing grievances.
Practice within the scope of authority.
Follow organizational policies and procedures and OSHA safety guidelines; protect confidentiality and maintain a safe working environment.
Participate in and support quality improvement initiatives.
Participate in continuing education, required staff and training meetings, and maintain professional affiliations and required certifications.
Perform other duties as required.