Social Work Specialist: Geriatric Care Coordinator

7 days ago

Lynn, Massachusetts, United States Element Care Full time
About the Role

Element Care is seeking a skilled Social Work Specialist to join our team as a Geriatric Care Coordinator. This role plays a vital part in providing exceptional care and support to older adults, ensuring they live safely and comfortably in their homes and communities.

About the Job

We are looking for a professional with expertise in traditional social work services, particularly in geriatric care. As a Geriatric Care Coordinator, you will participate in planning, implementing, and evaluating care plans that meet the objectives, standards, and policies of the PACE model of care.

Responsibilities
  • Collaborate with the Interdisciplinary Team (IDT) on initial assessments, care planning, and ongoing re-assessments of participant care.
  • Attend IDT meetings, actively participating by sharing pertinent information, providing follow-up on assigned tasks, and helping develop participant care plans.
  • Complete all assigned assessments, including initial, semi-annual, annual, service request, and significant event assessments.
  • Assess participants' psychosocial needs and provide supportive counseling, working collaboratively with behavioral health providers.
  • Facilitate hospital, rehabilitation, and nursing home admissions and discharges as determined by the IDT, ensuring PASRR documentation is completed for NH admission.
  • Assist in converting participants from community to long-term care, working collaboratively with Medicaid Specialists, skilled nursing facilities, and participants' caregivers to complete conversions.
  • Arrange and facilitate family meetings as needed.
  • Refer participants and families to appropriate community services and act as a liaison/advocate with community organizations on behalf of participants.
  • Maintain accurate and timely social service documentation in participants' medical records.
  • Conduct participant council meetings as assigned.
  • Work collaboratively with the Director of Social Work and Behavioral Health providers to ensure guardianship is up-to-date, educate participants about healthcare proxies, and assist participants in completing HCP forms.
  • Work with the fiscal department to maintain participant insurance benefits and complete required documentation in medical records.
  • Review care plans with participants, guardians, and/or activated healthcare proxies as assigned.
  • Authorize home care and other approved services in a timely and accurate manner.
  • Visit participants at home or in skilled nursing facilities to assess their needs as indicated.
  • Collaborate with the Palliative Care team and assist with end-of-life planning as necessary.
  • Provide timely communication to staff regarding disenrollment, conversion to long-term care, transfer of sites, participant/caregiver demographic changes, and allegations of abuse.
Requirements
  • CURRENT LICSW OR LCSW LICENSE IN MASSACHUSETTS REQUIRED
  • A minimum of 1 year experience in Social Work providing traditional clinical or case management services with a geriatric population
  • Current CPR certification or ability to become certified
  • Treat all participants with professionalism and respect.
  • Strong verbal, written, and listening skills with the ability to multitask in a fast-paced environment
What We Offer
  • $83,500 - $96,000 per year
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Paid time off
  • Retirement plan
  • Supplemental benefits

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