Social Worker LCSW - Per Diem at BoldAge PACE summary: The Licensed Clinical Social Worker (LCSW) at BoldAge PACE provides comprehensive psychosocial assessments, counseling, and care coordination for elderly participants to promote independence and quality of life. The role involves crisis intervention, behavioral health support, and interdisciplinary collaboration to address complex medical and social needs. Responsibilities include developing care plans, conducting home visits, and supporting participants and caregivers through transitions and advanced care planning.

Join BoldAge PACE and Make a Difference!

BE PART OF OUR MISSION! Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: We listen to our participants and their caregivers to truly understand their needs and desires.

Why work with us? A People First Environment:  We make what is important to those we serve important to us. Make an Impact:  Enhance the quality of life for seniors. Professional Growth : Access to training and career development.

JOB SUMMARY: The Licensed Clinical Social Worker (LCSW or highest degree of clinical licensure in the state) is responsible for delivering comprehensive clinical social work services to participants enrolled in the Program of All-Inclusive Care for the Elderly (PACE). The LCSW conducts psychosocial assessments, develops and implements care plans, provides counseling, and coordinates services across the interdisciplinary team to support frail elders in maintaining independence and quality of life in the community. This role emphasizes behavioral health support, complex case management, crisis intervention, and the integration of psychosocial and medical care.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Complete initial and periodic psychosocial assessments for new and existing participants in collaboration with the Interdisciplinary Team (IDT). Participate in IDT meetings and contribute to the development and revision of individualized care plans. Provide clinical counseling, psychotherapy, and mental health interventions to participants and their families/caregivers. Address complex behavioral health needs, including substance use, depression, cognitive decline, grief/loss, and adjustment disorders. Coordinate with medical, behavioral health, and community providers to ensure continuity and appropriateness of services. Provide crisis intervention and support for urgent behavioral health or social needs. Educate and support participants and caregivers regarding advanced care planning, community resources, and long-term care options. Assist with transitions of care, including hospitalization, rehabilitation, and disenrollment, ensuring appropriate follow-up and advocacy. Conduct home visits as needed to assess living conditions and family dynamics. Document all assessments, care plans, interventions, and communications in the electronic health record in a timely and professional manner. Participate in quality improvement initiatives and contribute to program development regarding social work and behavioral health services. Perform other duties as assigned. EXPERIENCE AND EDUCATION: Master’s degree in Social Work (MSW) from a CSWE-accredited program. Current, active LCSW license in the state of employment. Minimum of two (2) years of post-MSW experience in clinical social work; at least one (1) year working with older adults, frail populations, or in community-based settings preferred. Previous experience in a healthcare setting, interdisciplinary care team, or behavioral health strongly preferred.

PRE-EMPLOYMENT REQUIREMENTS: All Employees - Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance. Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact. Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.

BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Keywords: Licensed Clinical Social Worker, LCSW, psychosocial assessment, behavioral health, care coordination, elderly care, crisis intervention, care planning, interdisciplinary team, mental health counseling