Licensed Masters Social Worker - LMSW

Job Details Level: Experienced

Job Location:

Bluestem PACE
- McPherson, KS 67460

Position Type:
Full Time Education Level: Graduate Degree

Travel Percentage :
Up to 25%

Job Shift: Day
- Minimal Call Job Category:
Health Care Bluestem PACE is looking for a full-time Licensed Masters Social Worker (LMSW) to join our team!

Join our team and enjoy outstanding benefits!

At Bluestem Communities, we value our full-time team members and offer a benefits package designed to support both your personal and professional well-being. As a full-time employee you can enjoy the following benefits:

• Health, dental and vision insurance
• Flexible Spending Accounts (medical & childcare available)
• AFLAC products
• Voluntary life insurance

• 401(k) plan with company match
• Gradifi student loan payment program
• Payactiv:
  Early access to earned wages

• Group term life and AD&D insurance
• Short-term disability insurance
• Employee Assistance Program (EAP)

• Paid Time Off (PTO) and six (6) paid holidays
• Bluestem Wellness Center membership
• Meal discounts at our dining locations

Our benefits are designed to help you thrive both personally and professionally. Explore the full range of benefits and learn more about how Bluestem Communities can be the right fit for you—visit our Careers page today!

The primary responsibility of the Licensed Masters Social Worker (LMSW) is to organize and implement social work services for PACE participants and families including but not limited to: participant social work assessment; treatment; and teaching and counseling of participant, caregiver or other appropriate representatives/family to maintain participant support in the community.

• Perform in-person initial assessments for enrollment of potential PACE participants to obtain a complete psycho-social history, to include: descriptions of cognitive status, social supports, family dynamics, mental health and substance dependency, and other current issues and needs.
• Collaborate with the interdisciplinary team to develop a comprehensive care plan for each participant.
• Conduct in person reassessments of enrolled participants every six months and as needed when participants’ conditions change.
• Maintain regular attendance at and participate in daily Interdisciplinary Team meetings, communicate participant changes and collaborate with team members in care planning decisions and coordination for 24-hour care delivery.
• Act as liaison with participant, caregivers, and community agencies regarding orientation to and ongoing relations with Interdisciplinary Team, day center, and other PACE staff.
• Provide ongoing support, counseling, and education to participants and family regarding a variety of issues, including but not limited to: the aging process, dementia, grief and loss, end of life, disease processes, difficult family dynamics and changing roles, PACE model and PACE health services.
• Work proactively to maintain participant housing through intervention with participant, caregivers, and housing. Provide referrals to subsidized housing and assisted living residences. This may involve completing applications, obtaining medical records, accompanying participants to interview assessments and tours if participant has no other support systems.
• Assist participant to function at most independent community level possible.
• Present requests to Interdisciplinary Team for and coordinate admission/discharge to contracted facilities for temporary respites and permanent placement.
• Perform home visits quarterly, or as needed, to assess living environment and support system.
• Act as facilitator for meetings with participant, family, caregivers, and community agencies to clarify or problem solve issues, including plan of care. Mediate discussions between all parties.
• Perform visits at hospital within 24 hours of admission or on Monday if participant is admitted on Friday or weekend. Coordinate hospital discharges in conjunction with interdisciplinary team and communication with attending physician. Communicate with family or caregivers frequently and as needed to update.
• If end of life care is appropriate, actively provide emotional support, grief counseling, education, and funeral/financial planning referral. Facilitate end of life or nursing home placement as needed.
• Initiate referrals to external resources with community agencies such as Adult Protective Services, Housing Authority, or public utility companies.…