PACE Social Services Support Specialist

Neighborhood Healthcare; Murrieta (CA); On-site; USD 41,000 - 57,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Vacation & Holidays

403b Retirement plan

Volunteer Time Off

Job summary

Neighborhood Healthcare is seeking a Social Services Support Specialist for the PACE program to assist social workers, coordinate community resources, and support participants and families in navigating the PACE system. This onsite role emphasizes documentation, referrals, and care coordination.

The position focuses on age-in-place support, with duties including team meeting prep, discharge planning assistance, and compassionate customer service.

Qualifications

• Bachelor's Degree in Social Work, Psychology, Sociology, Counseling, Human Services, Public Health, Education or related field required; OR Associate Degree in same fields AND 2 years of case management support, outreach, or resource coordination may be considered in lieu of a bachelor’s degree
• One year of social work experience preferred
• One year of elderly population experience preferred
• Bilingual (English/Spanish) preferred
• BLS certification required upon hire and maintained
• CPR and First Aid certification required for all PACE employees

Responsibilities

• Assist MSW Social Workers by managing documentation, organizing participant communications, and preparing community resource materials
• Help coordinate referrals to community resources (food, housing, utility, caregiver support)
• Follow up on service referrals and document progress in EMR
• Assist in organizing participant care team meetings and take notes
• Support discharge planning coordination (gather paperwork, arrange transport)
• Maintain resource lists and contact logs
• Participate in team huddles and meetings offering input
• Provide customer service to participants and caregivers via phone, email, or in person
• Serve as liaison between PACE Social Worker and Participant/decision-maker
• Provide telephone support and home visits when indicated
• Ensure confidentiality and HIPAA compliance
• Participate in group activities and community events
• May require local travel to participant homes or community organizations

Skills

Verbal & written communication

Community resources familiarity

Multitasking

Planning & organization

EHR experience

Compassionate demeanor

Teamwork & independence

Education

Bachelor's Degree

Associate Degree + 2 yrs experience

Tools

EHR systems

Case management platforms

Job description

About Us

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.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

ROLE OVERVIEW And PURPOSE

Working under the supervision of the Social Work Manager, the Social Services Support Specialist supports the delivery of high-quality, non-clinical psychosocial services to participants enrolled in the PACE program. This role focuses on administrative support, coordination of community resources, and assistance to participants and their families in navigating the PACE system. The Social Services Support Specialist plays an important role in promoting participants’ safety, well-being, and independence- with the goal of helping them age in place and remain safely at home for as long as possible.

Schedule: Monday-Friday, 8am-5pm. This position is onsite.

• Assist MSW Social Workers by managing documentation, organizing participant communications, and preparing community resource materials, enabling clinical staff to focus on direct support and care planning
• Help coordinate referrals to community resources such as food assistance, housing programs, utility assistance, and caregiver support services
• Follow up on service referrals and document progress in the participant's electronic medical record (EMR)
• Assist in organizing participant care team meetings or interdisciplinary team (IDT) meetings by preparing documents and taking notes as needed
• Support the Social Workers in discharge planning coordination (e.g., gathering paperwork, arranging transport, confirming resources)
• Help maintain accurate and up-to-date resource lists, contact logs, and participant communication records
• Participate in team huddles and departmental meetings, providing input on logistical or service coordination issues
• Provide friendly, culturally competent customer service to participants and caregivers via phone, email, or in person
• Serves as a liaison between the PACE Social Worker and the Participant or the Participant’s decision‑maker, providing instruction, guidance, or advice
• Provides telephone support and visits Participants in their homes when indicated
• Ensures confidentiality and compliance with HIPAA and organizational policies
• Participates in Participant group activities, support groups, outings, etc.
• May require local travel to participant homes or community organizations

Qualifications

Education/Experience

• Bachelor's Degree in Social Work, Psychology, Sociology, Counseling, Human Services, Public Health, Education or a related field required; OR Associate's Degree in Social Work, Psychology, Sociology, Counseling, Human Services, Public Health, Education or a related field AND 2 years of case management support, outreach, or resource coordination may be considered in lieu of a bachelor’s degree
• One year of social work experience preferred
• One year of experience working with the elderly population preferred
• Bilingual (English/Spanish) preferred
• Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines- may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards

• In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually.

Additional Qualifications (Knowledge, Skills And Abilities)

• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Familiarity with community resources and navigating public assistance programs
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Experience using electronic documentation systems (e.g., EHRs or case management platforms).
• Compassionate and professional demeanor when working with vulnerable populations
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

COMPLIANCE (Safety & HIPAA)

• Follows all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintains current knowledge of policies and procedures as they relate to safe work practices
• Follows all safety procedures and reports unsafe conditions
• Uses appropriate body mechanics to ensure an injury free environment
• Familiarity with location of nearest fire extinguisher and emergency exits
• Follows all infection control procedures including blood‑borne pathogen protocols
• Maintains privacy of all patients, employees and volunteer information and access such information only on a need‑to‑know basis for business purposes
• Comply with all regulations regarding corporate integrity and security obligations
• Reports all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!

Pay range: $29.71 - $41.59 per hour, depending on experience.

Compensation Disclosure

The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.