Social Services Coordinator

Join the team voted Best Place to Work in North County! At Gary and Mary West PACE, we support your personal and professional well-being with meaningful work, work/life balance, and opportunities to make a real difference in the lives of North County seniors and their families.

About the role

Under the direction of the Center Director, this role coordinates and supports all aspects of the Social Services Department as a key member of the interdisciplinary team (IDT). You will track tasks, manage schedules, prepare assessments, and ensure seamless care coordination for participants.

Responsibilities

• Participate as a supportive member of the IDT, tracking all components and assigned tasks associated with the Social Services Department and assigned IDT MSW.
• Attend morning IDT meetings and report status of tasks and assignments pertaining to the coordination of social service activities for all assigned participants.
• Coordinate and manage the MSW schedule for in-person assessments, including change of conditions, service delivery request/denial assessments, care conferences, and higher level of care assessments and committee meetings.
• Prepare the MSW for assessments, conferences, and higher level of care meetings.
• Prepare the MSW for and attend care planning meetings with IDT.
• Present care plans to participants and obtain signatures to be uploaded to the electronic medical record.
• Administer psychometric scales as needed for the MSW – including PHQ-9 and GAD-7.
• Work closely with participants and families to establish and maintain exemplary rapport and ongoing relationships to provide the highest quality of care in a person-centered, trauma-informed manner.
• Coordinate ongoing family meetings, as needed.
• Monitor the individual interventions prescribed in the plan of care and update medical record regularly.
• Alert SW/BH staff of crises that arise in the day center or in the community.
• Maintain current, accurate, professionally written case management records submitted within 72 hours of all encounters pertaining to a participant's care, including documentation of all communication, services provided, participant expressed wishes, and statuses.
• Act as liaison between the participant and other agencies such as Department of Aging, Social Security Administration, Medicaid, etc.
• Alert the MSW to needed referrals to community or specialized programs when indicated.
• Assist with obtaining and maintaining current statements of income and other assets.
• Participate in participant-related conferences in the community as designated.
• Maintain confidentiality of participant information.
• Attend monthly meetings with supervisor and bi-weekly mandatory department meetings.
• 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 the schedule of hours worked.
• Use of personal vehicle required.

Requirements

• High School Diploma or GED.
• Current Basic Life Support and CPR certification.
• Current California Driver's License with proof of auto insurance.
• Medical clearance for communicable diseases and up-to-date immunizations before direct participant contact.
• Successful pre-employment drug screen, background check, and physical assessment.

Qualifications

• A minimum of one year of experience working with a frail or elderly population.
• A minimum of one year of experience working in a behavioral health or social services setting.
• Excellent written and verbal communication skills with the ability to interact effectively with internal and external customers.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, vendors, medical staff, and the public.
• Proficiency in Microsoft computer applications; experience with Electronic Medical Record (EMR) systems preferred.
• Desire to work in the helping field with an emphasis on the geriatric population.

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, is a non-profit delivering medical, social, and behavioral services to frail elderly in North County San Diego. This PACE center is entrepreneurial, focusing on innovations and new processes in the traditional PACE environment.

Benefits

• Generous pay and a comprehensive benefits package focused on health and wellness.
• 11 paid holidays, 13 days of PTO, and 5 days of sick time.
• 5% employer match to our 403(b) retirement plan.
• No on-call time – your time matters.
• Annual education allowance and commitment to professional growth.
• Supportive, mission-driven culture where collaboration feels like family.