Senior Medical Caseworker

PACE Place provides coordinated medical and social services to elders who want to remain in their home but need support to do so. PACE Place provides Medical, Rehabilitation, In-Home Assistance, Transportation, Social Work, and Day Center services for patients in our care. Position Summary The PACE Social Worker (MSW) is responsible for planning, organizing, and delivering social work services to participants and their families enrolled in the PACE program. Key responsibilities include conducting comprehensive psychosocial assessments, developing and implementing care plans in collaboration with an interdisciplinary team, providing individual and family counseling, facilitating access to community resources, and advocating for participant needs to support continued community living. The MSW also plays a critical role in care transitions and serves as a liaison among participants, caregivers, the interdisciplinary team, and external agencies. Ramona Blvd, Jacksonville, FL 32205 and providing services in participant coverage area Shift: M-F with on call rotation $2500 Sign on bonus Offered Essential Functions Conduct in-person psychosocial assessments for new and existing participants to identify cognitive, emotional, and support needs. Collaborate with the interdisciplinary team to develop and update participant care plans. Attend and actively participate in daily interdisciplinary team meetings and support the coordination of 24-hour care delivery, including after-hours on-call responsibilities. Facilitate the use of social services and assist with housing, financial support, advance care planning, and legal documents (e.g., Perform home, hospital, and facility visits as needed for assessment, support, and discharge planning. Coordinate transitions in care including temporary respite, long-term placement, or disenrollment. Maintain timely and accurate documentation in participant medical records. Advocate for participants with external agencies such as Adult Protective Services and Housing Authorities. Ensure compliance with all regulatory and internal documentation, assessment, and service delivery requirements. Participate in continuing education and contribute to quality improvement efforts. Strong assessment, counseling, and case management skills. Skilled in documentation and professional writing. Proficient in Microsoft Office applications including Word, Excel, PowerPoint, and Outlook. Experience At least one year of experience working with a frail or elderly population (or must complete training upon hire). Preferably two years of experience on an interdisciplinary team in healthcare or community-based settings. License / Certification Current driver's license and auto insurance. Education Master's degree in Social Work from a Council on Social Work Education (CSWE)-accredited program. Other Requirements Medical clearance and current immunizations. Must be able to work in various settings, including homes, clinics, and nursing facilities. This description does not constitute a contract of employment, and employment with the organization is at-will, meaning either the employee or the organization may terminate the relationship at any time, with or without cause or notice. ADA Statement / Disclaimer PACE Place is committed to complying with all applicable provisions of the Americans with Disabilities Act (ADA), as amended. We provide reasonable accommodations to qualified individuals with disabilities to ensure equal access to employment opportunities and the ability to perform the essential functions of a position. If you require an accommodation to complete the application process, interview, or perform the essential functions of a role, please contact Human Resources at [email removed]. Where applicable, and as required by law, employment with PACE Partners of Northeast Florida may be contingent upon successful completion of a background screening initiated by the organization through the Florida Agency for Health Care Administration (AHCA) Background Screening Clearinghouse. Equal Opportunity Employer Employment Type: Full Time