Geriatric Social Worker - Care Coordination & CBT

PACE Southeast Michigan; Westland (MI); On-site; USD 52,000 - 70,000; Full time

Job summary

PACE Southeast Michgan seeks a Master’s Social Worker (MSW) to independently assess needs and coordinate social services for participants and families. The MSW participates in the Interdisciplinary Team (IDT) and delivers care via bio-psychosocial assessments, CBT techniques, psychoeducation, and case management.

The role emphasizes comprehensive assessments, individualized treatment planning, care coordination, documentation in the EHR, and active advocacy to improve participant outcomes within

Qualifications

• MSW from an accredited school and Michigan licensure.
• Minimum of one year clinical social work experience.
• Knowledge of case management and patient-centered care.
• Familiarity with local/state/federal laws and cultural competence.
• Ability to learn and use an EHR system; proficient in Microsoft Office.

Responsibilities

• Perform comprehensive bio-psychosocial assessments at enrollment and 180 days.
• Develop and implement individualized plans of care for participants and caregivers.
• Coordinate services with the care team and conduct risk and crisis assessments.
• Advocate for participants and communicate care plans to IDT and families.
• Document accurately in the EHR and monitor progress toward goals.
• Assist in discharge planning and ensure follow-up after transition of care.

Skills

Bio-psychosocial assessment

Counseling (CBT/MI)

Care planning

Case management

Interdisciplinary teamwork

EHR documentation

Education

Master’s in Social Work (MSW)

Licensed to practice in MI

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft PowerPoint

Electronic Health Record (EHR) system

Job description

PACE Southeast Michgan seeks a Master’s Social Worker (MSW) to independently assess needs and coordinate social services for participants and families. The MSW participates in the Interdisciplinary Team (IDT) and delivers care via bio-psychosocial assessments, CBT techniques, psychoeducation, and case management.

The role emphasizes comprehensive assessments, individualized treatment planning, care coordination, documentation in the EHR, and active advocacy to improve participant outcomes within