Social Worker at Seen Health (Alhambra, CA)Social Worker

At Seen Health, we are revolutionizing the way senior care is delivered through the PACE (Programs of All-Inclusive Care for the Elderly) model. Backed by top VCs, Seen Health is a culturally-focused, technology-enabled healthcare organization that integrates comprehensive medical care and social support with a high-touch, interdisciplinary approach.

Our mission is to empower seniors to age-in-place with dignity and provide their families peace of mind. We are building upon a proven Home and community based services model to create a culturally-competent and scalable PACE program. We are also building a comprehensive operating system focused on data and workflows that span across systems, processes, people, and care contexts. We want to empower our clinicians and staff with tools that deliver relevant data at the time and site of care and enable them to deliver exceptional care to our participants, which improve clinical outcomes, participant & provider satisfaction, and ultimately our strength as an organization.

We are a mission-driven, multidisciplinary team with deep healthcare, technology, and operations expertise, each inspired by our own personal stories of caring for seniors in our lives. Our name, Seen Health, was chosen to reflect our commitment to provide the highest standard of care to underserved older adults while respecting and incorporating their individual beliefs, heritage, and values, so that they can truly be seen.

Plan, organize, and implement comprehensive social work services for participants enrolled in the PACE (Programs of All-Inclusive Care for the Elderly) program serving a significant Chinese- speaking elderly population in the San Gabriel Valley. Conduct psychosocial assessments to evaluate participant needs, develop and implement individualized care plans, and provide ongoing case management and supportive counseling to participants and their families, including Chinese-speaking participants and family caregivers. Coordinate care with physicians, nurses, therapists, caregivers, and community service providers to ensure integrated, culturally and linguistically responsive participant care. Communicate directly with participants and family caregivers regarding care needs, behavioral health concerns, available services, care transitions, and treatment and discharge planning. Arrange social services and community resources, facilitate care transitions, support behavioral management strategies, and assist with discharge planning. Maintain accurate clinical documentation in electronic health record systems, participate in interdisciplinary team meetings and quality improvement activities, and ensure compliance with PACE program requirements and applicable regulatory standards. Regular travel is inherent to the position and required to physicians’ offices, hospitals, community organizations, outreach events, and other settings throughout the San Gabriel Valley community. Requirements: Employer will accept a master’s degree in Social Work and 1 year of experience in the job offered or a healthcare social worker-related occupation. Associate Clinical Social Worker Licensure required.

Any amount of experience in the additional requirements below will be acceptable unless a specific amount is noted. Prior academic background or work experience to include the following skills:

1. One year working with frail and elderly population;
2. Conducting psychosocial assessments, care planning and case management;
3. Assisting persons with behavioral health & substance abuse issues;
4. Fluency in Chinese language (Mandarin or Cantonese) required. Salary: $105,000 to $120,000 per year. Job Location: Alhambra, CA. Email resume to meena@seenhealth.org and Reference Job Code #SW.