Social Worker

Seen Health, Inc.; Alhambra (CA); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k Plan

PTO & Leave

CME support

Job summary

Seen Health, Inc. in Los Angeles, CA is seeking a Social Worker to join our PACE team on-site in Alhambra. The role focuses on psychosocial assessments, care planning, counseling, and coordination with an interdisciplinary team to support participants and their caregivers.

The position requires an MSW and at least 1 year serving frail and elderly clients (3+ years preferred). Bilingual in Mandarin and/or Cantonese is a plus; CPR certification is required or obtainable.

Qualifications

• Master's degree from a school of social work accredited by the CSWE.
• Minimum one year experience with frail and elderly population, 3+ years preferred.
• Experience conducting psychosocial assessments, care planning and case management.
• Demonstrated ability to work in a multicultural and multidisciplinary team.

Responsibilities

• Conduct psychosocial assessments and participate in IDT meetings to develop care plans.
• Deliver and document social work interventions, arrange resources, assist with transitions, provide counseling and case management.
• Complete assessments and updates; evaluate social service and caregiver support needs.
• Coordinate care conferences and communicate with care teams and family.

Skills

Communication

Bilingual (Mandarin/Cantonese)

Education

Master's degree in Social Work (MSW)

Job description

About Seen Health

At Seen Health, we are revolutionizing the way senior care is delivered through the PACE (Programs of All-Inclusive Care for the Elderly) model. Backed by top VCs, Seen Health is a culturally-focused, technology-enabled healthcare organization that integrates comprehensive medical care and social support with a high-touch, interdisciplinary approach.

Our mission is to empower seniors to age-in-place with dignity and provide their families peace of mind. We are building upon a proven Home and community based services model to create a culturally-competent and scalable PACE program. We are also building a comprehensive operating system focused on data and workflows that span across systems, processes, people, and care contexts. We want to empower our clinicians and staff with tools that deliver relevant data at the time and site of care and enable them to deliver exceptional care to our participants, which improve clinical outcomes, participant & provider satisfaction, and ultimately our strength as an organization.

We are a mission-driven, multidisciplinary team with deep healthcare, technology, and operations expertise, each inspired by our own personal stories of caring for seniors in our lives. Our name, Seen Health, was chosen to reflect our commitment to provide the highest standard of care to underserved older adults while respecting and incorporating their individual beliefs, heritage, and values, so that they can truly be seen.

About the Role

The Social Worker plans, organizes and implements social work services to participants and their caregivers in accordance with Seen Health policies and all applicable regulations. As an integral member of an Interdisciplinary Team, the social worker performs psychosocial assessments, develops and implements plans of care, conducts counseling and case management, and facilitates communication between the participant, family, caregivers, PACE staff, and provider support network, as appropriate.

Responsibilities

• Conduct Social Work assessments to determine the psychosocial needs, preferences and goals of the participants and actively participate in IDT meetings to develop participant care plans.
• Deliver and document social work interventions as agreed upon in the participants’ care plans including but not limited to arranging necessary resources and services, assisting with care transitions, providing individual as well as group counseling and case management.
• Completes initial assessments, re-assessments, and care plan updates for participants while continually evaluating the participants’ social service needs and caregiver support needs.
• Participates in regularly scheduled behavioral management meetings with other mental health professionals.
• Work with the primary care physician and other members of the care team to guide smooth care transitions between settings (e.g., hospitals, skilled nursing facilities, home, etc.).
• Assists physician, or intermediate care provider, and other team members in understanding the significant social and emotional factors related to participant health problems.
• Acts as a resource to other team members and staff regarding topics such as dementia, difficult behaviors, and difficult personalities. Supports the IDT in establishing behavior management plans.
• Strive for continuous growth and development of cultural competency exhibiting an understanding, awareness, and respect for diversity.
• Maintains accurate and timely documentation and paperwork including participants’ electronic medical records according to policies and procedures.
• Provides referral support to community resources and participates in inter-agency coordination of care.
• Develops and maintains working relationships with community agencies, such as the Department of Social Services, psychiatric facilities, skilled nursing facilities, hospitals, social agencies, and may participate in hospital and/or SNF discharge planning.
• Initiate, coordinate and facilitate care conference meetings to ensure the highest level of care coordination among other care team members, participants, and other people within the participants’ support network (family, informal caregivers etc.).
• Responds to, investigates, and reports complaints of elder abuse.
• Maintains the confidentiality of all company procedures, results and information about participants, clients or families in conformance with Health Insurance Portability and Accountability (HIPAA) principles.
• Active contributor and change agent to continuously achieve quality care, participant experience and compliance goals.
• Proactively supports participant grievance and incident reporting processes.
• Completes timely discharge planning.
• Conducts home visits and travel to hospital facilities and/or other community agency, as needed.
• Participate in state and federal audit preparation activities.
• Performs related duties as assigned.

Qualifications

• Master’s degree from a school of social work accredited by the Council on Social Work Education.
• Minimum one year experience working with frail and elderly population. (3+ years social work experience preferred).
• Experience conducting psychosocial assessments, care planning and case management skills required.
• Demonstrated ability to work in a multicultural and multidisciplinary team environment.
• Excellent oral and verbal communication and meeting facilitation skills.
• Previous experience assisting persons with behavioral health & substance abuse issues, preferred.
• Current CPR certification or the ability to obtain CPR certification is required.
• Require personal transportation, current state issued driver’s license, good driving record and auto insurance as required by law.
• Bilingual required - Mandarin and/or Cantonese

Location

• Los Angeles required.
• On Site at Seen Health in Alhambra; home and community facility visits as needed.
• Relocation benefits available.

Salary & Benefits

• Salary: $90K - $110K / year
• Equity: may be included as part of team package
• Benefits: Seen Health is proud to offer a robust benefits offering for our employees. In addition to traditional healthcare coverage, we also offer additional benefits to help further your wellness and feeling of being part of the team.
  • Medical, Dental, and Vision benefits for you and your family
  • Life Insurance and Disability Benefits
  • Parental and Caregiver Leave
  • Lunch, as well as delicious snacks and coffee to keep you energized
  • Paid Time Off across holidays, vacation time, personal days, and sick days
  • 401k Plan
  • Personal and professional development, including CME support and career growth opportunities
  • Subscriptions and training on using AI tools including ChatGPT

Seen Health does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, gender identity, pregnancy, national origin, age, disability, creed, ancestry, genetic information, marital status, sexual orientation/identity, transgender status, military or veteran status, or any other characteristic protected by federal, state, or local law. This prohibition includes unlawful harassment based on any of these protected classifications.