LCSW Per diem, Pre-Enrollment (PACE)

Role Scope:

We are seeking a dedicated and experienced Licensed Clinical Social Worker to serve as our Per Diem Pre-Enrollment LCSW for our PACE program. In this per diem capacity, you will conduct comprehensive psychosocial assessments and eligibility evaluations for prospective PACE participants on an as-needed basis, ensuring they meet both clinical criteria and Health and Safety requirements for community-based care. You will work collaboratively with our interdisciplinary enrollment team to facilitate safe transitions into our program while advocating for older adults’ autonomy and dignity.

• Conduct comprehensive psychosocial assessments for prospective PACE participants during the pre-enrollment process, evaluating cognitive, emotional, behavioral, and social functioning

• Perform specialized assessments for behavioral health and psychosocial referrals, reviewing complex cases identified by the Enrollment team.

• Evaluate applicants' capacity for informed consent and decision-making regarding PACE enrollment and care planning.

• Assess whether prospective participants with mental health conditions, cognitive impairment, or behavioral challenges can be safely managed in community-based settings per Health and Safety regulations

• Complete detailed social histories, including family dynamics, support systems, housing stability, financial resources, and cultural considerations

• Administer standardized assessment tools (PHQ-9, GAD-7, MMSE, MoCA, GDS, ADL/IADL scales) and interpret results within the context of geriatric best practices

• Collaborate with the interdisciplinary team to develop preliminary care plans and identify immediate service needs prior to enrollment.

• Provide crisis intervention and safety planning when indicated during the assessment process.

• Document all assessments, recommendations, and eligibility determinations in accordance with PACE regulatory requirements, Title 22 standards, and organizational policies

• Serve as a liaison between prospective participants, families, and community resources during the transition to PACE enrollment

Qualifications:

• Current, unrestricted Licensed Clinical Social Worker (LCSW) license in California

• Master's degree in Social Work (MSW)

• Minimum of 1 years of post-licensure clinical experience, with at least 2 years working with older adults and geriatric populations

• Strong knowledge of geriatric mental health, including dementia care, depression, anxiety disorders, and age-related psychological changes

• Experience conducting comprehensive psychosocial assessments and biopsychosocial evaluations for complex older adults

• Experience with standardized geriatric assessment tools (BIMS, PHQ-9, MoCA, MMSE) and interpreting results for eligibility determination

• Understanding of California's LCSW scope of practice as defined in Business & Professions Code Sections 4996-4999.129

• Knowledge of capacity assessment principles and ability to evaluate decision-making abilities in older adults with cognitive impairment

• Experience with crisis intervention, safety planning, and risk assessment in community-based settings

• Excellent clinical documentation skills that meet regulatory standards and demonstrate medical necessity

• Proficiency with Epic electronic health record system or similar EHR platforms

• Experience working in interdisciplinary team environments and collaborative care models

• Understanding of CMS and DHCS regulations related to PACE enrollment criteria and Health and Safety requirements

• Knowledge of Medicar