Social Worker Lead - Sterling Heights

The Social Worker Lead (Licensed Master’s Social Worker) (LMSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers.

The LMSW is a member of the Interdisciplinary Team (IDT) and participates in the assessment, intervention, management, and review of social service needs. The LMSW also assists the IDT in determining eligibility and care needs.

The LMSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management.

Additionally, the Lead Social Worker is responsible for daily clinical management, supervision, and oversight of social workers.

Specific Duties and Functions

In addition to carrying a full social work caseload and being responsible for associated roles and responsibilities (see below), the Lead Social Worker is responsible for the daily clinical management, supervision, and oversight of social workers.

Under the leadership of the Clinical Manager, the Lead Social Worker provides direct oversight at their respective center.

Lead Social Workers participate in the Social Work Leadership Council, which formulates and monitors departmental goals and outcomes and revises strategy based on performance outcomes.

Ensures social work staff are effectively participating in the Interdisciplinary Team (IDT) for participant care and coordination.

• Partners with the center leadership team to ensure effective operations and clinical activities.
• Provides clinical supervision to limited licensed social workers and interns employed at PACE Southeast Michigan and ensures professional development and continuing education for all social workers employed at the Lead’s respective center.
• Represents the department on various process/quality improvement projects, initiatives, and committees.

Ensures compliance to departmental and organizational standards and all state and federal regulatory requirements.

Routinely audits social work care plans, assessments, progress notes, Level of Care Determination (LOCD) paperwork, and disenrollment paperwork. Ensures accurate, clinically appropriate, and timely completion of documentation.

Performs other related duties, as assigned by leader(s).

The LMSW is a member of the IDT and performs a comprehensive bio-psychosocial assessments upon enrollment and at 6 and 12 month intervals thereafter. Acute assessments are completed on an as-needed basis and aim to answer specific referral questions. Utilizes measurement-based care.

Develops and implements appropriate, individual treatment plans for both Participants and caregivers, including but not limited to:

Individual and/or group counseling (utilizing Motivational Interviewing and CBT techniques)

Education

• Consultation services to the Care Team
• Risk Assessment/Crisis Intervention
• Directs case management Issues, including but not limited to:
• Housing Issues

Financial Issues

Safety Issues including, but not limited to: symptoms of abuse, neglect or exploitation; ability to live independently; decision-making capacity; any other issues warranting involvement of Adult Protective Services (APS)

Psychiatric: Changes in mood, behavior, cognition/mental status; suicidal/homicidal ideation; substance use/misuse

Caregiver Burden

Identifies the need to transfer to a higher level of care (e. g., Behavioral Health Services).

• Assists in coordinating discharge planning activities and processes.
• Assists in coordinating 24-hour care as indicated by interdisciplinary team.

Educates and counsels the participant and/or caregiver regarding care needs, options and other related problems.

Advocates to others on behalf of the participant, and demonstrates accountability in resolving participant concerns or issues.

Works collaboratively to develop and communicate initial impressions, plans of care, changes in care, and progress in a timely fashion.

• Helps to develop and complete the plan of care with the IDT, participant, and/or caregiver.
• Completes timely and accurate documentation in the electronic health record (EHR).
• Communicates changes in participants with IDT and family members.
• Evaluates participant outcomes and or progress toward achieving the objectives and goals of the care plan and communicates this information among other members of the IDT.
• Performs other related duties, as assigned by leader(s).

Knowledge, Skills and Abilities

Master’s Social Worker from an accredited school of social work.

Licensed to practice in the State of Michigan. LMSW required.

Three years' experience working as a clinical social worker, preferably in the field of geriatrics. Knowledge of the principles of human behavior, individual and group therapy techniques (preferably CBT and DBT), short-term interventions, and substance use disorder assessment and treatment.

One year experience in supervision/management/leadership. May be substituted by other demonstration of leadership potential and/or abilities.

• Skilled facilitator and problem solver with excellent communication and interpersonal skills.
• Demonstrated 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 an ability to care for a diverse population.

Ability to learn and use electronic health record system. Auditing experience preferred.

• Proficient in Microsoft Word, Excel, Outlook, PowerPoint.
• Positive, flexible, and solution-focused attitude with ability to collaborate effectively in a team setting.