PACE Social Worker-MSW

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 350k medical, dental, and behavioral health visits from more than 77k people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

We have been doing this since 1969 and it is our employees that make this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If that sounds like an organization you want to be a part of, we would love to have you.

Position Summary:
The Social Worker at NHC PACE contributes the profession’s unique psychosocial perspective to the inter-disciplinary evaluation, assessment, plan of care, ongoing services, and disenrollment processes that occur once NHC PACE participants begin the intake process and continue with ongoing PACE care and support services. The PACE Social Worker collaborates with the PACE interdisciplinary team to ensure effective, efficient and appropriate care along the PACE care continuum in order to optimize the health status and quality of life of all NHC PACE participants.

The PACE Social Worker is responsible for direct social work case management services to NHC PACE program participants and provides such social services support as participant screening, case management, counseling and referral. The PACE Social Worker follows all policies and procedures of the NHC PACE Center, applicable laws and licensing requirements at all times.

Full-time: 30 hours a week.

Essential Functions of the Job:

• Participates in the NHC PACE Inter Disciplinary Team's initial assessments, care planning and periodic re-assessments (minimally every 6 months) of participant's case.
• Communicates participant changes to team members.
• Maintains current written case management records, including periodic reassessments of program participants.
• Provides in-home assessments for all participants. Completes social service assessments on all participants.
• Coordinates 24-hour care delivery.
• Provides individual and family counseling, develops and leads group counseling and activities.
• Refers participants and families to appropriate community agencies or facilities, acts as liaison with such organizations and as advocate for PACE participants.
• Encourages effective relationships among staff geared to team building and maintenance of a cohesive team.
• Consults with and advises staff members as 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.
• Participates in Program and Policy development of Social Work component.
• Documents participant changes appropriately in the medical record.
• Actively participates as a member of the Interdisciplinary Team. Attends staff meetings and takes part in participant care planning.
• Maintains a working knowledge of facility service areas including transportation, community characteristics and geography.
• Maintains a networking liaison with other organizations in the eldercare field.
• May be requested to represent the agency in contact with human service, health care, and community organization groups and individuals.

Additional Duties and Responsibilities:

• Enhances professional growth and development through participation in educational programs current literature, in-service meetings and workshops.
• Adheres to and models NHC’s core values and behaviors of Excellence, Empowerment, Integrity and Respect.
• Adheres to NHC attendance and punctuality policies and practices.
• Assists participants to fill out Adult Meal Benefit forms upon enrollment and annually.
• Performs other related duties as assigned or requested.

MINIMUM QUALIFICATIONS:

• Minimum level of education and experience): Master's Degree from an accredited School of Social Work. Preferred: Experience as a Clinical Social Worker
• One year in clinical healthcare setting and experience working with the frail or elderly population.

Certifications/Licenses Required:

• Valid California driver’s license. Reliable transportation must be properly insured to meet Center’s guidelines.
• Preferred: First Aid/CPR certification,
• California Social Work licensure.

Verbal and Written Skills Required: Excellent oral and written communication skills.

Technical Knowledge and Skills Required:

• Skills in counseling theory and techniques.
• Bilingual English/Spanish. Preferred: Knowledge of community resources and their use to meet the needs of families.
• Has organization and project management skills.
• Ability to establish and maintain good interpersonal relationships.
• Ability to work independently and meet deadlines. Individual therapy skills for geriatric participants, analytical thinking and problem-solving abilities. I
• ncludes Home Visits to private homes of PACE Center participants, frequent travel in Riverside and San Bernardino counties.
• Only acts within the scope of his or her authority to practice.
• Meets a standardized set of competencies for the specific position description established by NHC PACE before working independently.

Working Conditions and Physical Requirements (Sitting/Standing/Walking/Lifting/Noisy): Prolonged periods of sitting and standing. Frequent walking. Driving within city. Lifting of no more than 15 lbs. Ability to remain calm and objectively evaluate problems. May be required to work outside normal working hours.

Neighborhood Healthcare requires employees to be fully vaccinated (including a booster dose) against COVID-1 and demonstrate proof of vaccination/booster upon hire or receive approval for an exemption based on a medical reason, disability or religious belief. Proof of booster dose will be contingent upon booster eligibility._