Social Worker Case Manager

Description

Who We Are

Are you interested in working for an organization whose mission is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?

Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.

Job Summary

The Social Work Case Manager is responsible for providing direct social work case management services to participants.

Essential Job Functions

Duties include but are not limited to:

· Follow social work directives from interdisciplinary team (IDT) and meet with family members and other community 

  members/agencies as needed. 

· Coordinate ongoing family meetings, as needed.

· Provide ongoing case management and advocacy as required.

· In conjunction with the interdisciplinary team, coordinate discharge planning for participants returning home from hospital or 

  nursing facility.

· Maintain current, written case management records, including ongoing documentation of services provided, and participants 

  expressed wishes.

· Act as liaison between the participant and other agencies such as Department of Aging, Social Security Administration, 

  Medicaid, etc.

· Participate in participant-related meetings with external agencies and conferences in the community as needed.

· Assist with ongoing government program financial eligibility applications for participants, including recertification as needed.

· Identify housing resources for participants offered by the community/county. Assist participants with housing resources such as 

  eligibility forms, applications, and navigating various housing options. 

· Conduct home visits, as needed.

· Assist in connecting with hard-to-reach participants. 

· Maintain confidentiality of participant information. 

· Attend and participate in staff meetings, in-services, projects, and committees as assigned. 

· Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.

· Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.

· Be flexible in schedule of hours worked.

· May require use of personal vehicle

Working Conditions and Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· Ability to access all areas of the center throughout the workday.

· Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of 

  another qualified employee when attempting to lift or transfer objects over 25 pounds.

· Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, 

  occasional bending, reaching forward and overhead; squatting and kneeling.

· Ability to communicate verbally with an excellent comprehension of the English language.

· Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment. 

Requirements

Experience

· Preferred one (1) year of documented experience in working with a frail or elderly population required.

· Prefer experience in a community-based setting or geriatric program.

Knowledge, Skills, and Abilities

· Interest in the risk-based long-term care program to serve frail elderly in a community-based setting.

· Experience and thorough knowledge of social service principles and practices.

· Knowledge of psychosocial, behavioral, and family needs of the elderly population.

· Knowledge of financing mechanisms such as Medicare, Medicaid, and Prospective Payment Systems.

· Knowledge of the local and social service delivery systems and aging network.

· Proven ability to work in an interdisciplinary team.

· Ability to work effectively and harmoniously with the staff, the elderly, and providers of services, public, and private agencies.

· Energetic, dependable, resourceful, and flexible.

· Effective oral and written communication skills.

· Computer skills required.

Education and Certification

· Bachelor’s degree in social work or related field required.

· CPR with First Aid certification.

· Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant 

  contact.

Core Values

· Respect at the core of our interactions.

· Honesty and Integrity with every endeavor

· Patient – Centered care aligned with participant values, beliefs, and preferences. 

· Encouragement that motivates and empowers others to be the best they can be. 

· Quality Care that is efficient, transformative and innovative. 

Salary : $20 - $25