Social Worker MSW - PACE

Company: Boldage pace
Location: Fresno
Posted on: April 20, 2025

Job Description:

Join BoldAge PACE and Make a Difference!


BE PART OF OUR MISSION!

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: We listen to our participants and their caregivers to truly understand their needs and desires.

Why work with us?

A People First Environment: We make what is important to those we serve important to us.

Make an Impact: Enhance the quality of life for seniors.

Professional Growth: Access to training and career development.

Competitive Compensation: BoldAge offers a robust benefits package, including medical, dental, paid time off, 401K, life insurance, tuition reimbursement, flexible spending account, and an employee assistance program.

Social Worker

JOB SUMMARY

Responsible for the direct social work care management services to the participants of the PACE program. Provides social service support such as participant screening, case management, counseling and referral. Plans, organizes and implements social work services for PACE participants and families. Responsibilities include but are not limited to: participant social work assessment; treatment; and teaching and counseling of participant, caregiver or other appropriate representatives/family to maintain participant support in the community. Social Worker interventions may also include: individual participant contacts; appropriate collateral contact; participant and family education, assessment, and counseling; assistance with locating resources; addressing mental health needs as they arise; ongoing case management; advocacy to ensure participant and caregiver needs are met and addressed; and disenrollment procedures. The Social Worker is the liaison between the interdisciplinary team, caregiver representatives, and community agencies.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Participate in the Interdisciplinary Team's initial assessments, care planning and periodic re-assessments (minimally every 6 months) of the participant's case in accordance with industry and departmental standards. Assessments are to be completed prior to the scheduled team meetings.
• Document participant changes appropriately in the medical record in accordance with industry and departmental standards.
• Communicate effectively and openly with other Interdisciplinary Team members on participant status and needs.
• Maintain current written case management records, including periodic reassessments of program participants.
• Coordinate 24-hour care delivery and provide individual and family counseling for participants.
• Develop and lead group counseling and activities.
• Refer participants and families to appropriate community agencies or facilities, act as a liaison with such organizations, and as an advocate for participants.
• Encourage effective relationships among staff geared toward team building and maintenance of a cohesive team.
• Consult with and advise staff members in regard to the relationship of social, emotional and cultural factors to health and medical care, and as to the availability of social services in the community.
• Participate in program and policy development in regard to social work; demonstrate active participation in QI processes.
• Perform home visits to private homes of PACE participants;
• Participate as a member of the Interdisciplinary Team: attend staff meetings and take part in participant care planning.
• Other projects and duties as assigned.
  
  REQUIREMENTS
  
  
• Master's degree in Social Work from an accredited school of social work
• Member of the Academy of Certified Social Workers (ACSW) or other NASW-recognized certification preferred
• Current License in the required state.
• Two (2) years of experience working on an interdisciplinary team in a hospital, nursing home or community-based setting is preferable.
• Hmong speaking required
• 1 year of experience working with a frail or elderly population preferred. If this is not present, training on working with a frail or elderly population will be provided upon hiring.
• Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
• Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.
  
  SKILLS AND ABILITIES
  
  
• Work effectively in a team environment.
• Communicate effectively and have interpersonal and conflict resolution skills.
• Familiarity with the psycho-social issues of the frail and chronically ill and their caregivers.
• Ability to provide psychosocial assessment and individual, family and group counseling.
• Ability to maintain accurate records and to prepare clear and concise reports, correspondence and other written materials.
• Good public speaking skills with all size groups.
• Effective verbal and written communication skills.
• Individual therapy (psycho-social) techniques for geriatric participants.
• Basic computer skills and use of electronic mail.
• Analytical thinking and problem solving skills.
  
  BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
  
  Monday - Friday
  8:00am - 4:30pm
  40 hours
  

Keywords: Boldage pace, Clovis , Social Worker MSW - PACE, Healthcare , Fresno, California