Social Worker - Rivertown

PACE Southeast Michigan; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

PACE Southeast Michigan seeks a Master’s Social Worker (MSW) to independently assess needs, coordinate social services, and participate in the IDT for comprehensive care planning. Responsibilities include bio-psychosocial assessments, treatment planning, counseling, and discharge coordination.

The role requires a Michigan-licensed MSW with at least one year of clinical social work experience, strong case management skills, and proficiency with EHR systems and Microsoft Office applications.

Qualifications

• Master’s Social Worker from an accredited school of social work.
• Licensed to practice in the State of Michigan.
• One year experience as a clinical social worker, preferably in geriatrics.
• Knowledge of case management, short-term interventions, and patient-centered care.

Responsibilities

• Perform comprehensive bio-psychosocial assessments at enrollment and at 180-day intervals.
• Develop and implement individual treatment plans for participants and caregivers.
• Provide counseling using Motivational Interviewing and CBT techniques.
• Coordinate services with the care team and advocate for participants and caregivers.

Skills

Case management

Short-term interventions

Cultural competence

EHR use

Education

MSW (Master’s in Social Work)

Michigan licensure

Tools

EHR system

Microsoft Word

Excel

Outlook

PowerPoint

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 theInterdisciplinary 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

The MSW is a member of the IDT and performs a comprehensive bio-psychosocial assessments at the time of enrollment (initial) and 180-day intervals thereafter. Acute assessments are completed on an as-needed basis and aim to answer specific referral questions. Utilizes measurement-based care. Develops and implements appropriate, individual treatment plans for both participants and caregivers, including but not limited to: Counseling (utilizing Motivational Interviewing and CBT techniques) Education Coordination of services in collaboration with the care team Risk Assessment/Crisis Intervention Directs case management Issues, including but not limited to: Housing Issues, including identifying least restrictive setting in accordance with participant’s level of income affordability Financial Issues Safety Issues including, but not limited to: symptoms of abuse, neglect or exploitation; ability to live independently; decision-making capacity; any other issues warranting involvement of Adult Protective Services (APS) Psychiatric: changes in mood, behavior, cognition/mental status; suicidal/homicidal ideation; substance use/misuse Caregiver Burden Identifies the need to transfer to a higher level of care. Assists in coordinating discharge planning activities and processes. Educates and counsels the participant and/or caregiver regarding care needs, options and other related problems. Advocates to others on behalf of the participant and demonstrates accountability in resolving participant concerns or issues. Works collaboratively to develop and communicate initial impressions, plans of care, changes in care, and progress in a timely fashion. Helps to develop and implement the plan of care with the IDT, participant, and/or caregiver. Completes timely and accurate documentation in the electronic health record (EHR). Communicates changes in participants with IDT and family members. Evaluates participant outcomes and progress toward achieving the objectives and goals of the care plan and communicates this information among other members of the IDT. Performs other related duties, as assigned by leader(s).

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 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 an ability to care for a diverse population. Ability to learn and use electronic health record system. Proficient in Microsoft Word, Excel, Outlook, PowerPoint. Positive, flexible, and solution-focused attitude with ability to collaborate effectively in a team setting.

At PACE Southeast Michgan our employee experience is a combination of everything that’s unique about our culture, mission, vision, values, and most importantly, our people. Our employees are compassionate, curious, accountable, courageous, and authentic. They make choices according to what is best for our participants and strive to make a difference. For several years, they have made us a Top Workplace in our area.