Social Worker - Center Line

PACE Southeast Michigan; Center Line (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

PACE Southeast Michigan is seeking a Master’s Social Worker (MSW) to work with participants and families in a collaborative, interdisciplinary team. This role involves bio-psychosocial assessments, care planning, and crisis intervention, using CBT techniques and psychoeducation as part of comprehensive social services.

The MSW provides counseling, coordinates services with the care team, documents in the EHR, and advocates for participants to address housing, safety, and other needs within

Qualifications

• Master’s Social Worker degree from an accredited school of social work.
• Licensed to practice in the State of Michigan.
• One year of experience as a clinical social worker, preferably in geriatrics.

Responsibilities

• Performs comprehensive bio-psychosocial assessments at enrollment and at 180-day intervals.
• Develops and implements individualized treatment plans including counseling and psychoeducation.
• Coordinates services with the care team and conducts risk assessment and crisis intervention.
• Assesses psychiatric changes, SI/HI, substance misuse, and caregiver burden.
• Documents in the electronic health record (EHR) timely and accurately.
• Advocates for participants and communicates care plans with the IDT and families.

Job description

SUMMARY

The Master’s Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers. The MSW is a member of the Interdisciplinary Team (IDT) and participates in the assessment, intervention, management, and review of social service needs. The MSW provides care through a variety of modalities, including but not limited to bio‑psychosocial assessment, interventions that include cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management.

SPECIFIC DUTIES AND FUNCTIONS

• Performs comprehensive bio‑psychosocial assessments at enrollment and at 180‑day intervals.
• Conducts acute assessments as needed to answer specific referral questions.
• Utilizes measurement‑based care.
• Develops and implements individualized treatment plans for participants and caregivers, including counseling (motivational interviewing and CBT techniques) and psychoeducation.
• Coordinates services in collaboration with the care team and performs risk assessment and crisis intervention.
• Manages case‑management issues such as housing, financial, and safety concerns, and initiates involvement of Adult Protective Services (APS) when warranted.
• Assesses psychiatric changes, suicidal/homicidal ideation, substance misuse, and caregiver burden.
• Assists in coordinating discharge planning and related processes.
• Educates and counsels participants and/or caregivers regarding care needs, options, and related problems.
• Advocates on behalf of participants and resolves concerns or issues.
• Communicates with the IDT and family members regarding care plans, changes in care, and progress.
• Documents timely and accurately in the electronic health record (EHR).
• Evolves and evaluates participant outcomes and progress toward achieving objectives and goals of the care plan.
• Performs other related duties as assigned by leaders.

KNOWLEDGE, SKILLS AND ABILITIES

– Master’s Social Worker from an accredited school of social work.
– Licensed to practice in the State of Michigan (limited license may be considered depending on experience and number of supervised hours).
– One year’s experience working as a clinical social worker, preferably in the field of geriatrics.
– Overall knowledge of case management skills, short‑term interventions, and principles of human behavior.
– Demonstrated knowledge and skill in evaluating, planning, implementing, and monitoring patient‑centered approaches to care.
– Knowledge of and compliance with applicable local, state, and federal laws and regulations.
– Cultural competence and ability to care for a diverse population.
– Ability to learn and use an electronic health record system.
– Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
– Positive, flexible, and solution‑focused attitude with ability to collaborate effectively in a team setting.