MSW Social Worker – PACE & Community Care Leader

Blue Ridge Care; Winchester, Northern (VA, KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive Pay

PTO & Volunteer Time

Health, Dental & Vision Benefits

Tuition Reimbursement

Peer Support

Thrift Shop Discount

Growth Opportunities

Job summary

Blue Ridge Independence at Home is seeking a Medical Social Worker (MSW) to join the interdisciplinary team and support older adults and their families in living safely and independently in the community.

The role involves psychosocial assessments, care planning, discharge coordination, and home visits, with focus on counseling, advocacy, and problem-solving for complex needs. A Master’s in Social Work and relevant experience are required.

Qualifications

• Master’s Degree in Social Work from an accredited program.
• At least one year of experience providing services to older adults or individuals with developmental or physical disabilities.
• Case management experience preferred.

Responsibilities

• Complete psychosocial assessments for prospective and current participants.
• Develop individualized care plans and update them as needs change.
• Coordinate case management and discharge planning, including transitions of care between home, hospital, and other care settings.
• Complete home visits and home assessments.
• Participate in interdisciplinary team meetings and collaborate on care decisions.
• Support families with problem-solving, communication, and caregiving challenges.
• Provide counseling, crisis intervention, and advocacy.
• Assist with housing concerns, benefits navigation, and financial eligibility issues.
• Maintain accurate and timely case documentation in the EMR.
• Help participants complete advance directives or guardianship paperwork.
• Participate in cross-site meetings, trainings, and quality initiatives.
• Protect participant confidentiality and uphold ethical practice standards.
• Provide coverage for other sites as needed

Skills

Assessment skills

Counseling

Communication skills

Documentation skills

Driver’s license

CPR certification

Education

Master’s Degree in Social Work

Tools

EMR

Job description

Blue Ridge Independence at Home is seeking a Medical Social Worker (MSW) to join the interdisciplinary team and support older adults and their families in living safely and independently in the community.

The role involves psychosocial assessments, care planning, discharge coordination, and home visits, with focus on counseling, advocacy, and problem-solving for complex needs. A Master’s in Social Work and relevant experience are required.