Description

You will provide social work services to seniors and their caregivers in a PACE program, conducting assessments, developing care plans, and coordinating resources to help participants age in place with dignity. You'll collaborate with an interdisciplinary team to address psychosocial needs and ensure smooth care transitions.

Requirements

• Master of Social Work (MSW) degree
• Experience working with elderly populations
• Knowledge of community resources and care coordination
• Strong communication and documentation skills
• Ability to conduct home visits and travel to facilities

Responsibilities

• Conduct psychosocial assessments and develop participant care plans as part of an interdisciplinary team
• Deliver social work interventions including counseling, case management, and arranging resources
• Facilitate care transitions between hospitals, skilled nursing facilities, and home
• Maintain accurate documentation in electronic medical records
• Coordinate with community agencies and support discharge planning