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myPlace Health

Home-based integrated care delivery for elderly

Master's Level Social Worker - PACE

Case Management & AdvocacyPosted on Nov 11
Full-timeCompton, CA, USA

About the Job

Requirements

  • A Master's degree in Social Work (MSW) from an accredited university is required.
  • CPR and First Aid certification is required or must be obtained within 30 days of hire.
  • At least 2 years of experience conducting psychosocial assessments, care planning, and case management is required.
  • At least 2 years of experience working with frail or elderly populations is required.
  • A current California driver's license, a clean driving record, and personal automobile insurance are required.
  • The role requires the ability to lift, carry, or move items weighing up to 25 pounds when necessary.
  • The schedule is Monday through Friday, 8 a.m. to 5 p.m., onsite at the Compton center.

Responsibilities

  • Maintain a caseload of PACE participants and deliver social work services to participants and their families or caregivers.
  • Participate in daily interdisciplinary team meetings, conduct psychosocial assessments, and develop care plans during initial, semi-annual, annual, or emergency reviews.
  • Present assessments at care plan conferences to support collaborative care planning by the interdisciplinary team.
  • Collaborate with the interdisciplinary team to coordinate participant transitions among 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 needs.
  • Facilitate transitions between home and other placements, supporting participants throughout the process.
  • Support participants with Medi-Cal applications, monitor regulatory changes, and coordinate communications with government agencies.
  • Coordinate advanced care planning with providers to address participants' goals of care.
  • Design and lead group counseling sessions and activities that promote emotional well-being, personal growth, and social engagement.
  • Document care plans and interactions accurately and promptly in the electronic medical record.
  • Provide discharge planning support when participants transition out of the program.
  • Support the achievement of SCAN's vision and goals and perform other assigned duties.
  • Take on duties as assigned to support participant well-being and team success.

Desired Qualifications

  • Proficiency in electronic medical record or electronic health record documentation is preferred.
  • Experience collaborating with multidisciplinary or medical teams is preferred.
  • Bilingual abilities in English and Spanish, Cantonese, Mandarin, or Vietnamese are welcomed.

About the Company

myPlace Health

Home-based integrated care delivery for elderly

myPlace Health coordinates integrated, home-based care for older adults under the PACE program, partnering with Medicare/Medicaid and local health plans to deliver comprehensive services. A care team coordinates medical, social, and long-term supports and delivers them at home or in local settings, aiming to prevent hospitalizations and maintain independence. It differentiates itself by focusing on personalized, at-home care under the PACE framework and tying payments to health outcomes and quality of life rather than facility care. Its goal is to help vulnerable seniors stay in familiar surroundings while improving health and daily living.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Los Angeles, CA
Founded
2021

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