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PACE Southeast Michigan

In-home elder care with interdisciplinary team

Social Worker

Full-Time
No salary listed
Junior
Master's
Eastpointe, MI, USA
In Person
Social & Community ServicesCase Management & Advocacy

About the job

Requirements
  • A Master’s Social Worker degree from an accredited school of social work.
  • A license to practice in the State of Michigan; a limited license may be considered depending on experience and supervised hours.
  • At least one year of experience working as a clinical social worker.
  • Knowledge of human behavior, individual and group therapy techniques, preferably cognitive behavioral therapy and dialectical behavior therapy, short-term interventions, and substance use disorder assessment and treatment.
  • Knowledge and skill in evaluating, planning, implementing, and monitoring patient-centered approaches to care.
  • Knowledge of and compliance with applicable local, state, and federal laws and regulations.
  • Cultural competence and the ability to care for a diverse population.
  • Ability to learn and use an electronic health record system.
  • Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
Responsibilities
  • Assess participant and family or caregiver needs and coordinate and deliver social services.
  • Participate in the Participant Care Team and Interdisciplinary Team assessment, intervention, management, and review of social service needs.
  • Assist the Interdisciplinary Team in determining eligibility and care needs.
  • Provide bio-psychosocial assessments, individual and group counseling using motivational interviewing and cognitive behavioral techniques, psychoeducation, consultation, and care planning or case management.
  • Complete comprehensive bio-psychosocial assessments upon enrollment and at six- and twelve-month intervals, with acute assessments as needed.
  • Develop and implement individual treatment plans for participants and caregivers.
  • Provide education and consultation services to the Care Team.
  • Perform risk assessment and crisis intervention.
  • Direct case management issues involving housing, finances, safety, abuse, neglect, exploitation, independent living, decision-making capacity, psychiatric changes, suicidal or homicidal ideation, and substance use or misuse.
  • Identify the need to transfer participants to a higher level of care, such as Behavioral Health Services.
  • Assist with discharge planning activities and processes.
  • Assist in coordinating 24-hour care as indicated by the interdisciplinary team or Care Team.
  • Educate and counsel participants and caregivers regarding care needs, options, and related problems.
  • Advocate on behalf of participants and resolve participant concerns or issues.
  • Collaborate to develop and communicate initial impressions, plans of care, changes in care, and progress.
  • Help develop and complete plans of care with the Interdisciplinary Team, participant, and caregiver.
  • Complete timely and accurate documentation in the electronic health record.
  • Communicate participant changes with the Interdisciplinary Team and family members.
  • Evaluate participant outcomes and progress toward care-plan objectives and goals and communicate this information to the Participant Care Team and Interdisciplinary Team.
  • Perform other related duties assigned by leaders.
Desired Qualifications
  • Experience working as a clinical social worker in geriatrics.
  • Knowledge of cognitive behavioral therapy and dialectical behavior therapy techniques.

About the company

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PACE Southeast Michigan

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PACE Southeast Michigan provides comprehensive, in-home care for seniors through the Program of All-Inclusive Care for the Elderly (PACE). It helps eligible older adults stay independent at home by coordinating services via an interdisciplinary team that personalizes care for participants and their caregivers. The team meets daily to proactively communicate and coordinate holistic care, aiming to prevent avoidable emergency visits, hospitalizations, and nursing home placements. Serving Wayne, Macomb, and Oakland Counties, the program combines medical and social support to deliver high-quality, integrated care. Its goal is to keep participants healthy and at home for as long as possible while reducing unnecessary hospital use.

Company Size

51-200

Company Stage

N/A

Total Funding

N/A

Headquarters

Miusynsk, Ukraine

Founded

1994

Get referred to PACE Southeast Michigan

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Simplify's Take

What believers are saying

  • Michigan lawmakers introduced the PACE Improvement Act on September 24, 2026.
  • PACE Southeast Michigan is expanding Sterling Heights, Clinton Township, Eastpointe, and Detroit.
  • 2024 revenue reached $198.9 million, up from $171.8 million in 2023.

What critics are saying

  • The EEOC settled a disability suit against PACE for $170,000 on January 17, 2025.
  • That decree requires ADA training and annual reporting through 2028.
  • Heavy dependence on Medicaid and program revenue creates reimbursement exposure if enrollment slips.

What makes PACE Southeast Michigan unique

  • PACE Southeast Michigan runs nine centers across Macomb, Wayne, and Oakland counties.
  • Its all-inclusive PACE model bundles Medicare, Medicaid, transportation, meals, and home care.
  • It served over 2,000 participants in 2024, with 96% living in the community.

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Benefits

  • Flexible Work Hours