PACE SOCIAL SERVICES MANAGER

Lead and manage Social Work (SW), Homecare services, and Community Nursing across all PACE sites. Ensure coverage, high-quality participant-centered social services, contractor oversight, discharge coordination, RCFE admissions and tracking, Level-of-Care (LOC) submission oversight for candidates, quality improvement, regulatory compliance, and participant satisfaction/retention.

ESSENTIAL JOB FUNCTIONS:

• Provide direct supervision, training, coaching, and performance evaluation for social work, homecare, and community nursing teams.
• Ensure effective hiring, orientation, ongoing training, scheduling, coverage, and staffing across all PACE sites for social work, homecare, and community nursing services.
• Delegate responsibilities appropriately according to licensure, credentials, education, and experience.
• Develop policies and procedures for social work, homecare, and home health services.
• Drive participant engagement and retention initiatives, including outreach, care-plan engagement, satisfaction follow-up, and targeted interventions to reduce disenrollment.
• Lead the management and oversight of contracted homecare services, including contractor selection, contract performance monitoring, service-level expectations, invoicing reconciliation, and vendor relationship management.
• Lead the social work team in hospitalization discharge planning and coordination with hospitals, SNFs, IDT, and families to ensure safe transitions and timely return to community-based care.
• Lead RCFE contracting, referral/admission processes, capacity tracking, and ongoing relationship management with RCFE partners.
• Oversee Community RNs in preparing and submitting Level-of-Care (LOC) documentation for PACE candidate applications, including coordinating assessments, required documentation, submission timelines, and follow-up.
• Lead the Social Work team to monitor and resolve participant eligibility issues
• Oversee the quality of care delivered by homecare caregivers in participants homes
• Lead QI initiatives focused on social work and homecare services, tracking QI metrics, and implementing corrective actions.
• Monitor encounter, assessment, and care plan metrics for social work, homecare, and community nursing/home health services and identify opportunities to improve overall participant experience.
• Implement strategies to meet or exceed national and state participant satisfaction benchmarks for social work, homecare services, and behavioral wellness.
• Coordinate closely with PCPs, IDT members, and community providers to develop and implement individualized care and therapy plans.
• Oversee supplies, equipment, and workspace needs relevant to social work, homecare, and community nursing operations across sites.
• Resolve grievances related to social work, homecare, and community nursing issues in collaboration with Center Manager.
• Prepare for and participate in CMS, DHCS, and other regulatory audits and implement corrective actions as needed.
• Ensure accurate, cohesive, and timely documentation in participant medical records for all social work, homecare, and community nursing/home health activities.
• Oversee the quality of care and safety of PACE participants, both at the PACE center and in the community.
• Ensure compliance with all PACE regulatory requirements and internal policies.
• Travel between PACE sites, RCFEs, and participant residences as needed for supervision, training, audits, or to address service issues.
• Utilize Epic appropriately and efficiently and serve as content and workflow expert for resolving issues and proposing solutions in Epic.
• Perform other duties as assigned by the PACE Program Director.
• Bachelor's degree or higher in Social Work, Nursing, Gerontology, Public Health, Health Administration, or a related field.
• Minimum two years of experience in social work, care management, or community-based services.
• Minimum two years supervisory or team-lead experience in a healthcare setting; prior management of multidisciplinary teams strongly preferred.
• Demonstrated skills in supervision, leadership, and communication and in fostering an effective team environment.
• Minimum one year of experience working with older adults and their families in a healthcare or community agency setting is preferred.
• Ability to travel between PACE sites as needed.
• Current BLS and First Aid required.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluency in other languages is an asset.

STATUS:

This is an FLSA Exempt position.

This is not an OSHA high-risk position.