Social Services Case Manager

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as health plan, healthcare provider, and social center designed for older adults with complex medical needs. We have four adult day health centers that serve participants in Miami-Dade and Broward counties.

The following Job Description will also apply at Broward Pace Program sites.

Job Summary

Responsible for providing structured case management, Level of Care (LOC) assessment and coordination, participant monitoring, and service implementation support to participants of the MJHS PACE Program. Works collaboratively with the Interdisciplinary Team (IDT) to support care plan implementation, monitor participant stability, track eligibility requirements, and escalate psychosocial concerns to the master’s-level or licensed social worker as appropriate.

Essential Job Functions

• Conducts Level of Care (LOC) assessments in accordance with PACE program standards.

• Maintains current written case management records, including LOC renewals and eligibility tracking.

• Monitors Medicaid eligibility, redetermination timelines, and Long-Term Care (LTC) waitlist status.

• Participates in the interdisciplinary team process and supports implementation of IDT-approved care plans.

• Conducts routine participant check-ins and monitors changes in psychosocial stability.

• Tracks transition of care and communicates findings to the supervising social worker.

• Identifies missed visit patterns and escalates concerns appropriately.

• Assists participants and families with community resource navigation and benefit coordination.

• Communicates with Assisted Living Facilities (ALFs) as appropriate to support participant care continuity.

• Documents coordination activities in the electronic health record within established timeframes.

• Supports quality improvement initiatives and departmental KPI tracking.

• In emergent or time-sensitive situations, may collect preliminary assessment information under the supervision of the Director of Social Services or master’s-level/licensed social worker. All such documentation requires supervisory review and co-signature prior to finalization.

• May be required to float between PACE sites based on operational needs.

• Completes all necessary and required social work documentation

• Maintains current written case management records

• Interfaces with interdisciplinary staff members to share information on the Participant

• Assists with discharge planning

• Facilitates support groups

• Attends meetings as needed

• Performs other duties as assigned.

Job Requirements

Education

• Bachelor’s degree in social work or closely related field.

Experience

• At minimum one year of related experience in geriatrics, managed care, long-term care, or community-based case management or social services preferred.

Licenses/Certifications

• Florida DOEA 701-B Comprehensive Assessment certificate/training required or willingness to obtain within 6 months of hire.

Abilities Required

• Strong assessment, coordination, and organizational capabilities.

• Proven ability to perform effectively in a fast-paced social services environment.

• Exceptional communication, interpersonal, and counseling skills.

• Ability to collaborate effectively within an interdisciplinary team.

• Knowledge of geriatrics/gerontology and related community resources preferred.

• Demonstrated ability to work cooperatively with diverse professional disciplines.

• In-depth understanding of individual and family psychosocial dynamics.

• Bilingual proficiency in English and Spanish preferred.

• Proficiency in computer use and related technology.

Functional Demands

Environment Work Conditions

• Normal working condition with adequate lighting and ventilation

• Toxic or caustic chemicals; bio-hazardous waste; flammable, explosive gas

Infectious Material Exposure

• Routine exposure to blood/body fluids/tissues

Organizational Expectations

• Ensures that resident’s/patient’s rights are adhered to

• Demonstrates professionalism and accountability

• Demonstrates a caring attitude consistent with Miami Jewish EmpathicareSM toward MJH residents, patients, family members, employees, and other facility guests

• Demonstrates excellent communication skills

• Ensures confidentiality and security of patients’ medical information

• Identifies and utilizes appropriate channels of communication

• Able to speak, read and write English

• Able to think and act calmly to meet unusual occurrences of the job

• Adheres to the organization’s Mission, Vision and Values

• Participates in departmental activities, meetings and in-services and follows established guidelines

• Maintains a safe working environment

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

We believe in the power of empathy, the value of relationships and the importance of a life well-lived. Come see why Miami Jewish Health is unlike anywhere you’ve ever worked before. We offer competitive compensation, medical/dental/vision coverage and a 403(b)-retirement savings plan for eligible full and part-time positions, free on-campus parking, an onsite fitness center and more.

Miami Jewish Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Miami Jewish Health and FL PACE Centers conducts a Level II background check as part of the onboarding process for all new hires. The following link contains information and resources pertaining to the AHCA Level II background conducted at Miami Jewish Health and FL PACE Centers. FL Clearinghouse | Florida Agency for Health Care Administration