Under the direction of the Social Work Manager or designee, the Social Worker will provide social work services
including: advocating, assessing, assisting, collaborating, educating, evaluating, implementing and planning for
members in various aspects of the member’s life including but not limited to psychological, psychosocial,
financial, environmental and interpersonal matters Social work engagement takes place in various settings
including but not limited to the member’s home, PACE site, different community settings (hospitals, SNF, ALF’s,
etc.) The Social Worker will serve as the conduit among the member/family, the Interdisciplinary Care Team and
other community agencies (acute care institutions, APS, skilled nursing facilities, Assisted Living Facilities, etc.)
to ensure the highest level of satisfaction from the start of care throughout their PACE lifetime. The Social
Worker will provide support to the PACE member through teaching the adaptation to illness and/or disability and
treatment; assessing and evaluating psychosocial functioning; psychosocial discharge planning; facilitating the use
of services offered by other community agencies; crisis intervention; mental status examinations and support with
terminally ill patients.