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Posted 2 weeks ago

Masters Level Social Worker
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Job Description
What will success look like as our Masters Level Social Work?
- Engage in daily IDT meetings to ensure participants' voices are heard, conducting psychosocial assessments and developing care plans during initial, semi-annual, annual, or emergency reviews.
- Present assessments at care plan conferences, laying the foundation for collaborative care plans crafted by the IDT team.
- Collaborate seamlessly with the IDT to guide participants through smooth care transitions between settings, such as hospitals, homes, and long-term or short-term care facilities.
- Connect participants, families, and caregivers with community resources and provide ongoing support tailored to their unique needs.
- Facilitate transitions between home and other placements, ensuring participants feel safe, supported, and empowered throughout the process.
- Support participants with Medi-Cal applications, staying up to date with changing regulations and coordinating communications with government agencies to ease the process.
- Coordinate advanced care planning in partnership with providers, ensuring participants' goals of care are thoughtfully addressed.
- Design and lead group counseling sessions and activities to promote emotional well-being, personal growth, and social engagement.
- Document care plans and interactions accurately and promptly in the EMR, ensuring smooth coordination across the care team.
- Provide discharge planning support when participants transition out of the program, helping them navigate the next steps with confidence and care.
- Embrace flexibility and teamwork by taking on other meaningful duties as assigned to enhance participant well-being and team success.
Where's What Sets You Up For Success:
- Advanced training in social work: Master’s degree in Social Work (MSW) from an accredited university.
- Safety first mindset: CPR and First Aid certification required (or willingness to obtain within 30 days of hire).
- Hands-on clinical experience: At least 2 years providing psychosocial assessments, care planning, and case management support.
- Heart for older adults: Minimum 2 years working with frail or elderly populations, with a clear passion for protecting their dignity and well-being.
- Ready to hit the road: Current California Driver’s License, personal automobile insurance (as required by State law).
- Comfort with technology: Experience documenting in EMR/EHR systems preferred.
- Team player by nature: Prior experience working with multidisciplinary or medical teams to coordinate care is a strong plus.
- Language skills that make a difference: Bilingual abilities in English and Spanish, Cantonese, Mandarin, or Vietnamese are a big plus and warmly welcomed.
- Ability to support participants physically: Able to lift, carry, or move items up to 25 pounds, as needed, to support participant care and comfort.
Other pertinent information
- Where you’ll make an impact: Based in Los Angeles, CA (90057), with travel within our local service area as participant needs arise.
- When you’ll work: Monday–Friday, 8:00 a.m.–5:00 p.m., fully onsite so you can be present with participants and the care team.
- Who you’ll partner with: This role reports to our Behavioral Health Manager, joining a supportive team focused on whole-person care for our participants.
From Center to Community: Your Work Environment
- Meet participants where they are: You’ll spend your time both at our PACE center in Los Angeles and out in the community—visiting participants in their homes, apartments, assisted living facilities, skilled nursing facilities, and community sites like senior centers or partner agencies.
- Out and about in LA: This role includes regular local travel within our service area. You’ll be driving, navigating normal Los Angeles traffic, and walking between parking areas and participant locations.
- Real-world home environments: Participant homes won’t always look like a brochure—some may have stairs, narrow hallways, pets, smoke, strong odors, or clutter. We keep safety top of mind and make sure you feel supported and prepared for these visits.
- Center & clinic life: When you’re onsite, you’ll work in a professional healthcare setting—moving between offices, clinic rooms, and common spaces, spending time talking with participants, families, and the care team.
- Day-to-day physical expectations:
- * Periods of sitting, standing, walking, and speaking throughout the day
- * Regular computer and phone use for documentation and coordination
- * Ability to move around the center and community, climb stairs as needed, and occasionally lift or carry items (like supplies or small equipment) up to 25 pounds to support participant care.
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