Responsible for the direct social work care management services to the participants of the CalOptima PACE program. Provides social service support such as participant screening, case management, counseling and referral.
- Participate in the Interdisciplinary Team’s initial assessments, care planning and periodic re-assessments (minimally every 6 months) of the participant's case in accordance with industry and departmental standards. Assessments are to be completed prior to the scheduled team meetings.
- Document participant changes appropriately in the medical record in accordance with industry and departmental standards.
- Communicate effectively and openly with other Interdisciplinary Team members on participant status and needs.
- Maintain current written case management records, including periodic reassessments of program participants.
- Coordinate 24 hour care delivery and provide individual and family counseling for participants.
- Develop and lead group counseling and activities.
- Refer participants and families to appropriate community agencies or facilities, act as a liaison with such organizations, and as an advocate for participants.
- Encourage effective relationships among staff geared toward team building and maintenance of a cohesive team.
- Consult with and advise staff members in regard 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.
- Participate in program and policy development in regard to social work; demonstrate active participation in QI processes.
- Perform home visits to private homes of CalOptima PACE participants; frequent travel in Orange County.
- Participate as a member of the Interdisciplinary Team: attend staff meetings and take part in participant care planning.
- Other projects and duties as assigned.
- Work effectively in a team environment.
- Communicate effectively and have interpersonal and conflict resolution skills.
- Only act within the scope of his/her authority to practice.
- Meet a standardized set of competencies for the specific position description established by CalOptima PACE and approved by regulatory agencies before working independently.
- Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.
- Pass a criminal background which will verify that the candidate is: not excluded from participation in Medicare and Medicaid programs; has not been convicted of criminal offenses related to their involvement in Medicaid, Medicare, other health insurance or health care programs, or social services programs under title XX of the Act; and have not been convicted of physical, sexual, drug or alcohol abuse.
Experience & Education
- Master’s degree in Social Work from an accredited college or university.
- Minimum 2 years experience in a health related area.
- Minimum 1 year experience working with the frail or elderly population. Relevant experience must be within the last 3 years.
- Valid California Driver’s license and vehicle, or other approved means of transportation, and an acceptable driving record is required.
- Individual therapy (psycho-social) techniques for geriatric participants.
- Basic computer skills and use of electronic mail.
- Analytical thinking and problem solving skills.
CalOptima - 22 months ago