PACE Social Worker, MSW (San Ysidro, CA)

San Ysidro Health; California; On-site; USD 70,000 - 90,000; Full time

Job summary

San Ysidro Health is seeking a qualified social worker to provide direct social work case management for the San Diego PACE program. You will screen participants, manage cases, provide counseling, and refer participants to community resources to support health and well-being.

The ideal candidate holds a Master's Degree in Social Work, a valid California driver’s license, and strong skills in counseling, organization and teamwork.

Qualifications

• Master's Degree in Social Work from an accredited program.
• Valid California driver’s license and access to a vehicle.
• Experience in counseling theory and techniques.
• Ability to work independently and with interdisciplinary teams.

Responsibilities

• Participates in assessments and care planning with the Interdisciplinary Team.
• Maintains current case management records and reassessments.
• Provides in-home assessments and social service assessments.
• Offers individual and family counseling and leads group activities.
• Refers participants to community agencies and advocates for participants.
• Collaborates with staff to ensure cohesive team.
• Documents participant changes in medical records.

Skills

Counseling

Organization

Interpersonal relationships

Independent work

Analytical thinking

Education

Master's Degree in Social Work

Job description

Job Description

Posted Tuesday, August 4, 2026 at 10:00 AM

Position Summary:

Responsible for the direct social work case management services to the participants of the San Diego PACE program. Provides such social services support as participant screening, case management, counseling and referral. Follows all policies and procedures of PACE, applicable laws and licensing requirements at all times.

Essential Functions of the Job:

• Participates in the Interdisciplinary Team's initial assessments, care planning and periodic re-assessments (minimally every 6 months) of participant's case. Assessments are to be completed prior to the scheduled team meeting. Communicates participant changes to team members.
• Maintains current written case management records, including periodic reassessments of program participants.
• Provides in-home assessments for all PACE participants. Completes social service assessments on all participants.
• 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 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 SYHC's core values and behaviors of Excellence, Empowerment, Integrity and Respect.
• Adheres to SYHC and PACE 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.

Job Requirements:

Education Required:

Master's Degree from an accredited School of Social Work.

Certifications/Licenses Required:

Valid California driver's license and access to an insured vehicle.

Experience and Required Skills:

• Skills in counseling theory and techniques.
• Organization and project management skills.
• Ability to establish and maintain good interpersonal relationships.
• Ability to work independently and meet deadlines.
• Analytical thinking and problem-solving abilities.
• Only act within the scope of his or her authority to practice.

Verbal and Written Skills Required to Perform the Job:

Excellent oral and written communication skills.

Equipment Used:

Office equipment, including but not limited to, computers, phones, copy machines, fax machines.

Working Conditions and Physical Requirements:

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 of normal working hours.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.