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Social Worker, MSW

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Job Description - Social Worker, MSW


Join the Team Voted Best Place to Work in North County!


Why Work for Gary and Mary West PACE?


Because you're looking for more than just a job - you want work/life balance and the opportunity to make a meaningful impact in the lives of North County seniors and their families.


At Gary and Mary West PACE, we support your personal and professional well-being with:



  • Generous pay and a comprehensive benefits package focused on your health and wellness

  • 11 paid holidays, 13 days of PTO, and 5 days of sick time.

  • A 5% employer match to our 403(b) retirement plan.

  • No on-call time - because your time matters.


We invest in our team with an annual education allowance and a commitment to professional growth, helping you expand your skills and advance your career.


You'll thrive in a supportive, mission-driven culture where collaboration feels like family. As part of our multi-disciplinary team, your voice is heard, and your work is truly valued.


Join us and do your best work-because here, your contribution matters.


About PACE:


Philanthropists Gary and Mary West founded West Health with the mission of enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life, and independence. The Gary and Mary West PACE (Program of All-inclusive Care for the Elderly), affiliated with West Health (www.westhealth.org), is a non-profit that delivers medical, social, and behavioral services to the frail elderly to the North County of San Diego. This PACE center is entrepreneurial in nature and focuses on innovations and bringing new processes to the traditional PACE environment.


We're looking for passionate healthcare providers who want to be part of a team dedicated to enable seniors to live in their communities as independently as possible by providing compassionate, comprehensive health and supportive care.


One Team One Mission


Position Summary:


Under the direction of the Social Work Supervisor, is responsible for direct social work case management services to participants.


Essential Functions:



  • Participate as a member of the interdisciplinary team (IDT) and in initial, semi-annual, unscheduled, and annual assessments; attend morning updates and report changes in participants' baseline status to appropriate staff on a daily basis.

  • Involved in the development and implementation of QAPI activities.

  • Visit participant's home to assess for safety, living environment, support systems, and overall well-being, and to inform care planning and interventions as needed. This is an integral part of the job.

  • In conjunction with the IDT, may conduct the initial intake, meeting with family members and others. Coordinate ongoing family meetings, as needed.

  • Obtain extensive social history from participant and/or family member upon admission to program.

  • Provide individual and family counseling as needed or prescribed in the plan of care; develop and lead group counseling and support activities.

  • Provide crisis intervention and advocacy as required.

  • In conjunction with the interdisciplinary team, coordinate discharge planning for participants returning home from hospital or nursing facility.

  • Maintain current, written case management records, including ongoing documentation of services provided, reassessment of changing needs and participant's expressed wishes.

  • Act as liaison between the participant and other agencies such as Department of Aging, Social Security Administration, Medicaid, etc.

  • Assist with money management.

  • Assist with ongoing financial eligibility for participants, including recertification as needed.

  • Participate in participant-related conferences in the community as designated.

  • Maintain confidentiality of participant information.


Non-Essential Job Functions:



  • Attend and participate in all staff meetings, in-services, projects, and committees as assigned.

  • Adhere to and support the center's policies, practices, and procedures.

  • Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.

  • Be flexible in schedule of hours worked.

  • Will require use of personal vehicle.


Education and Certification:



  • Master's degree in social work required.

  • Original valid driver's license with proof of auto insurance.

  • Bilingual English/Spanish preferred.


Skills & Experience:



  • Minimum of one (1) year of documented experience in working with a frail or elderly population required.

  • Prefer experience in a community-based setting or geriatric program.


Medical Clearance:


Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.


Job offers are contingent upon a successful pre-employment drug screen, background check, and physical assessment.


Gary and Mary West PACE provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, gender, gender identity, gender expression or sexual orientation or any other considerations made unlawful by applicable state or local laws.


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