SUMMARY:
Under the supervision of the Intake Manager, the Participant Advocate is responsible for ensuring the smooth introduction and onboarding of all new enrollees into the PACE Southeast Michigan (PACE SEMI) Program. This includes – but is not limited to – escorting new intakes through their initial visit; introducing new participants to staff and other participants; providing education on PACE services; providing ongoing advocacy on behalf of participants; conducting weekly in-person or telephone follow up with new participants; and working directly with new participants and their caregivers for a smooth transition into PACE SEMI. This position is an intricate part of enhancing the customer service experience for new participants.
SPECIFIC DUTIES AND FUNCTIONS:
Serve as initial ambassador for potential participants and their caregivers.Provide support for newly enrolled participants as they learn structure of PACE SEMI.Represent Intake and Enrollment department in respective centers.Follow up with potential participant after initial home visit prior to enrollment to collect additional information and answer potential participant’s questions.Present potential participants to the interdisciplinary team (IDT) prior to enrollment.Develop initial care plan with home visit staff and IDT using assessments from home visit staff.Organize tours for potential participants and/or their caregivers, if requested.Facilitate pre-enrollment evaluations with PACE primary care or behavioral health, if required.Facilitate pre-enrollment evaluations with Henry Ford Health System specialists – pain management, substance abuse treatment, oncology, etc. – if required.Schedule center days with participant and PACE SEMI staff prior to enrollment.Make welcome calls to confirm enrollment and welcome packets including information on care teams, staff contact information, emergency plan, and medication refills.Conduct and document in electronic medical record (EMR) weekly in-person or telephone follow up prior to enrollment and for 90 days after enrollment to answer questions, provide education, and solicit concerns.Maintain communication with all new enrollees according to process to ensure understanding of PACE and participants’ needs.Act as a customer service liaison with participants and IDT.Other duties as assigned.KNOWLEDGE, SKILLS AND ABILITIES:
Associates degree required; bachelor degree preferred.Ability to effectively work both independently and as a team member.Demonstrate initiative and organizational skills.Minimum of one-year experience with a frail or elderly population; knowledge of health, social, and behavioral problems of the frail elderly.Demonstrate interest and ability to work in interdisciplinary team environment.Excellent communication skills.\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessFull-Time | Monday–Friday, 8am–5pm
Clinton Township
Nonprofit • Mission-Driven • Interdisciplinary Team
Make a Difference Where It Matters Most
PACE Southeast Michigan is a nonprofit organization dedicated to helping aging adults live safely, independently, and with dignity in their own homes. As a Behavioral Health Specialist, you’ll provide meaningful, participant-centered behavioral health care - not chase productivity quotas. This is clinical work with purpose, stability, and a team that genuinely has your back - “You are never on an island.”
Work Environment & Team Culture
Highly collaborative Behavioral Health team across all centers.Supportive, compassionate, and empathetic culture.Flexible structure - 4 days onsite and 1 day remote.
What You’ll Do
As a key member of our Interdisciplinary Team (IDT), you will:
Clinical Care:
Conduct biopsychosocial assessments, provide individual and group psychotherapy, and offer crisis intervention and urgent consultations.Deliver substance use disorder treatment and support participants during psychiatric hospitalizations.Follow through on interventions and treatment plans to ensure continuity of care.Educate participants and caregivers on behavioral health and psychosocial concerns.Collaboration & Consultation:
Serve as a liaison between Primary Care and Psychiatry.Work closely with the interdisciplinary team to refine diagnostic impressions and inform treatment plans.Provide behavioral health consultation, case reviews, and in-service training to colleagues.Documentation & Quality:
Complete timely, accurate EHR documentation.Ensure accessibility, safety, and quality in behavioral health services.Contribute to improvements in clinical guidelines and organizational practices.Professional Contribution:
Participate in committees, workgroups, staff development, and clinical training.Support broader organizational initiatives as assigned.
What We Offer
As a nonprofit, we prioritize quality care and work-life balance:
One remote workday per weekNo evenings or weekendsMission-driven work focused on quality, not quotasStrong interdisciplinary supportReasonable caseloadsCohesive, collaborative teams with strong leadershipProfessional development + opportunities for growthComprehensive benefits package: health insurance, dental, vision, 401 (k) matching, paid time off, paid holidaysStable salary starting at $59,700Eligible for Public Service Loan Forgiveness
What You Bring
Master’s in Social Work (required)LMSW or LLMSW (limited license candidates welcome)Strong clinical assessment and therapeutic skillsCommitment to collaborative, compassionate, person-centered careAbility to thrive in a team-oriented environment\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessPACE is currently hiring Recreational Therapist for our Day Health Center for Seniors in Detroit.
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our day health center.
Under the direction of the Activities & Recreation Program Leader, you’ll help plan and run group activities for participants in the PACE program. These activities are designed to support people emotionally, socially, physically, mentally, and spiritually. You’ll also share updates with your supervisor and the care team as needed.
You’ll take part in assessing new and current participants, share what you observe with the care team, and help create care plans that match each person’s individual needs. You’ll also look for ways to improve the recreation program over time.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Create and manage the monthly activity calendar.Make sure all planned activities actually happen.Design activities that fit participants’ abilities, interests, and needs.Lead group activities and keep participants engaged.Coordinate with transportation to plan outings in the community.Track and restock supplies and equipment.Complete all required paperwork on time (assessments, care plans, notes, etc.).Keep work areas clean, safe, and organized.Speak up for participants and report anything out of the ordinary.Work well with nurses, social workers, and the rest of the care team.Attend team meetings.Protect participants’ privacy.Follow safety and infection-control rules.Help with other tasks as needed.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Bachelor’s Degree in Recreation Therapy/Leisure Services.Be legally authorized to practice in Michigan. (A Certified Therapeutic Recreation Specialist certificate is required).Will only act within scope of his/her authority to practice.The physical ability to push occupied wheelchairs, furniture and to assist participants with ambulation.Must have one (1) year of experience with a frail or elderly population.\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessCNA OPEN INTERVIEW DAY
Looking for a rewarding career caring for seniors? Join us for our Open Interview Day and interview on the spot!
PACE Southeast Michigan - Clinton Township Center
Thursday, 8/6/26 and Friday 8/7/26
⏰ 10 am - 1 pm
19700 Hall Rd, Clinton Township, MI 48038
We are hiring Nursing Assistants, Medical Assistants, and Patient Care Technicians to provide compassionate care to older adults in a community living setting.
What we offer:
-8-hour shifts between the hours of 6:30 am - 5:30 pm
- M-F, no weekends, holidays or nights
-Supportive team environment
-Meaningful work making a difference every day
Bring a copy of your resume and be prepared for an on-the-spot interview.
We look forward to meeting you and discussing opportunities to join our team!
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our day health center.
Job Description
SUMMARY:
The Participant Care Associate (PCA), provides supportive services to the participant; including but not limited to in the home or community setting, during transport and on appointments, or and in the day health center. The PCA’s responsibilities for each participant are specified in the PCA/CNA Care Plan. The following statements are intended to describe the essential elements, functions, and requirements of the position. The list should not be taken as an exhaustive list of all responsibilities, duties, and skills required of an individual assigned to this job.
SPECIFIC DUTIES AND FUNCTIONS:
The PCA plan of care is based on the initial and on-going assessments that are performed by a home care RNCM.The PCA assists in providing and/or maintaining optimal physical and emotional comforts to frail elders, in the participant’s home, community setting, day health center, and dementia unit, and during transport and on appointments.The PCA assists participants and their families toward achieving maximum self-reliance and independence within their environment, day health center, and dementia unit.The PCA performs the care or services that are outlined in the individual participant’s Care Plan; any Care Guidelines that are pertinent to the participant’s diagnosis are specified in the Care Plan.The PCA performs a variety of tasks and services for the participant, including: Personal Care, Assistance with activities, Assistance with meal preparation/feeding, Assistance with toileting/managing incontinence, simple treatments, shopping, medication reminder, laundry services, extending hours care, homemaking services/chores, transportation and off site appointment support.The PCA is responsible for accurate timely documentation as required by the service area they are supporting; including but not limited to the care and/or services provided on every visit and or encounter, transport and appointment, on the PCA/CNA progress note; the PCA keeps the RNCM and or clinic nurse informed of the participant’s progress.Immediately reports all customer service complaints, all deviations from set schedule and appointments to supervisor / manager.The PCA responds to emergency situations in accordance with established policies and procedures.Works only within established scope of practice.
KNOWLEDGE, SKILLS AND ABILITIES:
H.S. diploma or GED requiredValid Michigan Driver's licenseCurrent CPR card requiredCertification is optional though preferred, but must have one (1) year experience with a frail or elderly populationExperience must be in a long-term care, hospital, or home care settingMust have received certificate of completion from a formal training program (Direct Care, Nurse Assistant, Medical Assistant, Patient Care Technician, etc.) outside of PACE SEMIThe PCA participates in annual, mandatory in-service training and screening, including but not limited to: infection control, TB testing, safety training, and BLS trainingThe PCA must possess the ability to establish and maintain interpersonal and interdepartmental relationshipsThe PCA shows respect for the physical, spiritual, and well-being of participants and co-workersThe PCA must have the ability to problem solve and interpret instructionsThe PCA must be able to organize and maintain flexible scheduling to coordinate job responsibilitiesAbility to work sensitively with individuals of diverse ethnic and cultural backgroundsAbility to relate to those participants with dementia and/or developmental disabilitiesThe PCA must be able to perform duties in an atmosphere of frequent interruptionMust meet a standardized set of competencies (approval by CMS) before working independentlyPCA competency is monitored and maintained in a variety of ways:Initially, through a skills check-off performance evaluation of specific tasks upon hire and orientation to the program, and annually thereafterJob related competency in-services including a practicum demonstration and written assessmentMandatory in-service trainingDepartment staff meetingsMust be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.\nCompany Description
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessPACE is currently hiring a Social Worker for our participants in the Westland area.
PACE Southeast Michigan is a nonprofit organization dedicated to helping aging adults live safely, independently, and with dignity in their own homes. As a Social Worker, you’ll provide meaningful, participant-centered social services - not chase productivity quotas. This is clinical work with purpose, stability, and a team that genuinely has your back - “You are never on an island.”
Under the leadership of the Social Work Manager, the Masters Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers. The MSW is a member of the Participant Care Team (PCT) and the Interdisciplinary Team (IDT) and participates in the assessment, intervention, management, and review of social service needs. The MSW also assists the IDT in determining eligibility and care needs. The MSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management.
SPECIFIC DUTIES AND FUNCTIONS:
The MSW is a member of the PCT and IDT and performs a comprehensive bio-psychosocial assessments upon enrollment and at 6 and 12 month intervals thereafter. Acute assessments are completed on an as-needed basis and aim to answer specific referral questions. Utilizes measurement-based care.
Develops and implements appropriate, individual treatment plans for both Participants and caregivers, including but not limited to:
Individual and/or group counseling (utilizing Motivational Interviewing and CBT techniques)
Education
Consultation services to the Care Team
Risk Assessment/Crisis Intervention
Directs case management Issues, including but not limited to:
Housing Issues
Financial Issues
Safety Issues including, but not limited to: symptoms of abuse, neglect or exploitation; ability to live independently; decision-making capacity; any other issues warranting involvement of Adult Protective Services (APS)
Psychiatric: Changes in mood, behavior, cognition/mental status; suicidal/homicidal ideation; substance use/misuse
Caregiver Burden
Identifies the need to transfer to a higher level of care (e.g., Behavioral Health Services).
Assists in coordinating discharge planning activities and processes.o Assists in coordinating 24-hour care as indicated by interdisciplinary team and/or the Care Team.
Educates and counsels the participant and/or caregiver regarding care needs, options and other related problems.
Advocates to others on behalf of the participant, and demonstrates accountability in resolving participant concerns or issues.
Works collaboratively to develop and communicate initial impressions, plans of care, changes in care, and progress in a timely fashion.
Helps to develop and complete the plan of care with the IDT, participant, and/or caregiver.
Completes timely and accurate documentation in the electronic health record (EHR).
Communicates changes in participants with IDT and family members.
Evaluates participant outcomes and or progress toward achieving the objectives and goals of the care plan and communicates this information among other members of the PCT and IDT.
Performs other related duties, as assigned by leader(s).
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessFull-Time | Monday–Friday, 8am–5pm
Pontiac
Nonprofit • Mission-Driven • Interdisciplinary Team
Make a Difference Where It Matters Most
PACE Southeast Michigan is a nonprofit organization dedicated to helping aging adults live safely, independently, and with dignity in their own homes. As a Behavioral Health Specialist, you’ll provide meaningful, participant-centered behavioral health care - not chase productivity quotas. This is clinical work with purpose, stability, and a team that genuinely has your back - “You are never on an island.”
Work Environment & Team Culture
Highly collaborative Behavioral Health team across all centers.Supportive, compassionate, and empathetic culture.Flexible structure - 4 days onsite and 1 day remote.
What You’ll Do
As a key member of our Interdisciplinary Team (IDT), you will:
Clinical Care:
Conduct biopsychosocial assessments, provide individual and group psychotherapy, and offer crisis intervention and urgent consultations.Deliver substance use disorder treatment and support participants during psychiatric hospitalizations.Follow through on interventions and treatment plans to ensure continuity of care.Educate participants and caregivers on behavioral health and psychosocial concerns.Collaboration & Consultation:
Serve as a liaison between Primary Care and Psychiatry.Work closely with the interdisciplinary team to refine diagnostic impressions and inform treatment plans.Provide behavioral health consultation, case reviews, and in-service training to colleagues.Documentation & Quality:
Complete timely, accurate EHR documentation.Ensure accessibility, safety, and quality in behavioral health services.Contribute to improvements in clinical guidelines and organizational practices.Professional Contribution:
Participate in committees, workgroups, staff development, and clinical training.Support broader organizational initiatives as assigned.
What We Offer
As a nonprofit, we prioritize quality care and work-life balance:
One remote workday per weekNo evenings or weekendsMission-driven work focused on quality, not quotasStrong interdisciplinary supportReasonable caseloadsCohesive, collaborative teams with strong leadershipProfessional development + opportunities for growthComprehensive benefits package: health insurance, dental, vision, 401 (k) matching, paid time off, paid holidaysStable salary starting at $59,700Eligible for Public Service Loan Forgiveness
What You Bring
Master’s in Social Work (required)LMSW or LLMSW (limited license candidates welcome)Strong clinical assessment and therapeutic skillsCommitment to collaborative, compassionate, person-centered careAbility to thrive in a team-oriented environment\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessJob description
PACE is currently hiring a Nursing Assistants / Medical Assistants / Patient Care Technicians for our Day Health Center for Seniors in Sterling Heights.
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our day health center.
Summary of Duties and Functions:
Assist participants with meals, hygiene and supports in accordance with person centered plans and plan of service.Assist participants and their families toward achieving maximum self-reliance and independence within their environment, day health center, and dementia unit.Perform the care or services that are outlined in the individual participant’s Care Plan; any Care Guidelines that are pertinent to the participant’s diagnosis are specified in the Care Plan.Responsible for accurate timely documentation as required by the service area they are supporting; including but not limited to the care and/or services provided on every visit and or encounter, transport and appointment, on the Nursing Assistant progress note; the Nursing Assistant keeps the RNCM and or clinic nurse informed of the participant’s progress.Immediately report all customer service complaints, all deviations from set schedule and appointments to supervisor / manager.Respond to emergency situations in accordance with established policies and procedures.Work only within established scope of practice.Job Requirements:
H.S. diploma or GED requiredCurrent CPR card requiredValid Michigan Driver's licenseMust have one (1) year experience with a frail or elderly population in a long-term care, hospital, or home care settingMust have received certificate of completion from a formal training program (Nurse Assistant, Medical Assistant, Patient Care Technician, etc.)Must be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.The Nursing Assistant participates in annual, mandatory in-service training and screening, including but not limited to: infection control, TB testing, safety training, and BLS trainingThe Nursing Assistant must possess the ability to establish and maintain interpersonal and interdepartmental relationshipsThe Nursing Assistant shows respect for the physical, spiritual, and well-being of participants and co-workersThe Nursing Assistant must have the ability to problem solve and interpret instructionsThe Nursing Assistant must be able to organize and maintain flexible scheduling to coordinate job responsibilitiesAbility to work sensitively with individuals of diverse ethnic and cultural backgroundsAbility to relate to those participants with dementia and/or developmental disabilitiesThe Nursing Assistant must be able to perform duties in an atmosphere of frequent interruptionMust meet a standardized set of competencies (approval by CMS) before working independentlyNursing Assistant competency is monitored and maintained in a variety of ways. Initially, through a skills check-off performance evaluation of specific tasks upon hire and orientation to the program, and annually thereafterJob related competency in-services including a practicum demonstration and written assessmentMandatory in-service training. Department staff meetingsBenefits:
Guaranteed Shifts (which means guaranteed pay!)Paid time off and holidaysHealth InsuranceDentalVisionShort & Long term disability401(k) matchingEmployee assistance programSchedule: Monday through Friday, 8 am - 5 pm. No weekends or holidays.
Pay: starting at $16.80 an hour, based on experience.
For more opportunities visit https://www.pacesemi.org/careers
\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessJob description
We are currently hiring transportation drivers for our Day Health Center for Seniors in Bloomfield Hills, MI.
PACE Southeast Michigan is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, the community, and our day health centers.
Tasks and responsibilities:
Transports participants to and from the program site or other assigned areas.Assists participants to and from the vehicle, to the participants' residence or the center.Participates in all scheduled education programs, in-services, or staff meetings as directed.Delivers medications, supplements, frozen meals, syringes, etc.Some of these extra duties include the following:Maintenance of the buses—adding oil to the motor, adding brake fluid, windshield wiper fluid, brake fluid, transmission fluid, putting air in tires, charging bus battery if bus won’t start, as well as, gassing bus and dropping off/picking up bus for repair.Daily wash and maintain a clean vehicle throughout shift.Requirements:
A valid, unrestricted, Michigan CDL license - Class A or B, with Passenger endorsement, and a driving record that falls into an acceptable category.A high school education or equivalent.Current CPR card.Must be capable of and experienced in transporting individuals with special mobility needs.Must meet a standardized set of competencies (approved by CMS) before working.Must be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.Must pass post-offer, pre-employment background check and health screening, including drug test, TB and MMR.Schedule: Monday through Friday, 8-hour shifts. Flexible hours. Overtime.
Pay: Starting at $18.53; based on experience.
Job Type: Full-time
Pay: $18.53 - $19.53 per hour
Benefits:
401(k) matchingDental insuranceEmployee assistance programFlexible scheduleFlexible spending accountHealth insuranceHealth savings accountPaid time offReferral programRetirement planVision insuranceSchedule:
8 hour shiftDay shiftMonday to FridayNo nightsNo weekendsSupplemental Pay:
Signing bonus\nCompany DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessUnder the leadership of the Social Work Manager, the Masters Social Worker (MSW) works independently to assess the needs of, coordinate, and deliver social services for participants and families/caregivers. The MSW is a member of the Participant Care Team (PCT) and the Interdisciplinary Team (IDT) and participates in the assessment, intervention, management, and review of social service needs. The MSW also assists the IDT in determining eligibility and care needs. The MSW provides care through a variety of modalities, including but not limited to, bio-psychosocial assessment, interventions that include individual and group counseling utilizing motivational interviewing, and cognitive behavioral techniques, psychoeducation, consultation, and care planning/case management.
SPECIFIC DUTIES AND FUNCTIONS:
The MSW is a member of the PCT and IDT and performs a comprehensive bio-psychosocial assessments upon enrollment and at 6 and 12 month intervals thereafter. Acute assessments are completed on an as-needed basis and aim to answer specific referral questions. Utilizes measurement-based care.
Develops and implements appropriate, individual treatment plans for both Participants and caregivers, including but not limited to:
Individual and/or group counseling (utilizing Motivational Interviewing and CBT techniques)
Education
Consultation services to the Care Team
Risk Assessment/Crisis Intervention
Directs case management Issues, including but not limited to:
Housing Issues
Financial Issues
Safety Issues including, but not limited to: symptoms of abuse, neglect or exploitation; ability to live independently; decision-making capacity; any other issues warranting involvement of Adult Protective Services (APS)
Psychiatric: Changes in mood, behavior, cognition/mental status; suicidal/homicidal ideation; substance use/misuse
Caregiver Burden
Identifies the need to transfer to a higher level of care (e.g., Behavioral Health Services).
Assists in coordinating discharge planning activities and processes.o Assists in coordinating 24-hour care as indicated by interdisciplinary team and/or the Care Team.
Educates and counsels the participant and/or caregiver regarding care needs, options and other related problems.
Advocates to others on behalf of the participant, and demonstrates accountability in resolving participant concerns or issues.
Works collaboratively to develop and communicate initial impressions, plans of care, changes in care, and progress in a timely fashion.
Helps to develop and complete the plan of care with the IDT, participant, and/or caregiver.
Completes timely and accurate documentation in the electronic health record (EHR).
Communicates changes in participants with IDT and family members.
Evaluates participant outcomes and or progress toward achieving the objectives and goals of the care plan and communicates this information among other members of the PCT and IDT.
Performs other related duties, as assigned by leader(s).
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read LessSUMMARY:
The Registered Nurse Case Manager (RNCM) of the PACE Southeast Michigan (PACE SEMI) utilizes a systematic approach to nursing practice which incorporates all aspects of the nursing process including, assessment, planning, implementation and evaluation of frail elders with complex needs. The RN demonstrates a direct relationship between nursing interventions and participant outcomes, demonstrates clinical competence and engages in effective patient teaching in areas of prevention as well as treatment. The RN effectively leads or directs licensed and non-professional nursing staff in the coordinated delivery of care to participants of the PACE Southeast Michigan program. The focus of care is one that enhances functional capacity, encouraging autonomy in all aspects of care, and assures coordination of all nursing care.
SPECIFIC DUTIES AND FUNCTIONS:
The RNCM assesses participants’ needs and plans for appropriate nursing care upon the Initial Intake Assessment as well as upon routine Re-Evaluation Assessments.The RNCM works and collaborates with the participant and the family, as well as all members of the multidisciplinary Team in developing the participant’s plan of care.The RNCM maximizes the participant’s functional capacity by encouraging autonomy in all aspects of care.The RNCM teaches, supervises and counsels the participant, or caregiver regarding nursing care needs and other related problems. The RN utilizes adult learning principles when planning for and implementing educational information to the participants, caregivers or family members.The RNCM initiates preventative and rehabilitative procedures or programs as appropriate for the participants’ care and safety.The RNCM administers medications and treatments, as ordered by the physician/NP, and monitors the participant’s response. The RN notifies the appropriate medical personnel of changes in the participant’s status.The RNCM demonstrates knowledge of the medications he/she administers and instructs the participant/family in safe administration of medication in the home. Assesses for and encourages compliance with medication regimen.The RNCM recognizes and understands the significance of abnormal test results and utilizes critical thinking skills when gathering participant data, planning for, and implementing care.The RNCM provides safe total patient care to participants with complex health problems with a focus on the individual participant and the family.The RNCM maintains all standards of nursing practice and follows hospital policies/procedures for care delivery and medication administration.The RNCM leads and monitors licensed and other professional and non-professional staff in the delivery of nursing care to the participant in the home. The RN is responsible for monthly supervision and subsequent documentation of home health aide services provided in the participant’s home.The RNCM evaluates participant outcomes and or progress toward achieving the objectives/goals of the care plan and communicates this information among other members of the Multidisciplinary Team.The RNCM collaborates with the Interdisciplinary Team to revise the plan of care based on changes in the participants’ physical or psychosocial status, and initiates actions that are consistent with the changes in status.The RNCN participates with patients, families and members of the Interdisciplinary Team to evaluate/measure the individual and group response to nursing care and teaching interventions and documents the outcomes of the problems identified at every scheduled review.The RNCM maintains accurate and timely records of participant’s functional /health status, progress toward care plan outcomes, revisions to care plans, care given, etc. All charting and documentation is performed in accordance with CSI policies/procedures. The RNCM participates in the collection and documentation of Data PACE information.The RNCM advocates to others on behalf of the participant, and demonstrates accountability in resolving participant concerns or issues.The RNCM understands, complies with and promotes the Participant Bill of Rights and assesses and works toward achieving high levels of participant satisfaction.The RNCM may provide after hours on-call medical assistance on a rotating basis, via phone triage or after hours home visits to participants as needed.Schedule requires a rotating on call shift.
\nCompany Description
PACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center.
Company DescriptionPACE is a "Best Place to Work" certified company. PACE (Program of All-Inclusive Care for the Elderly) is a unique health plan and care provider, committed to keeping aging adults with challenging healthcare conditions in their homes, by caring for their medical, physical, and social needs. PACE Southeast Michigan provides care and services in the home, the community, and our Day Health Center. Read Less