Geriatric Support Services Coordinator (Bilingual In Khmer) # 530

Elder Services of the Merrimack Valley and North Shore
Position Responsibilities: The GSSC will conduct health and functional assessment for elders enrolled in Senior Care Organizations (SCO). The GSSC will also develop and monitor service plans to promote the client's overall health and independence. The GSSC will work with an interdisciplinary team to assure effective coordination and delivery of care in the member's home.
Essential Functions: (Core duties or tasks that are fundamental and not marginal to the performance of the job
Conducts initial and ongoing assessments on new members/enrollees and completes the required assessment tools and computer data entry.

Conduct field visits to assess an older adult's physical, social, emotional and environmental status to determine their eligibility and needs in their homes in accordance with contract compliance.

Collaborates with the SCO RNCM to develop community care plans.
Supports and advocates for person centered planning.

Arranges, coordinates and authorizes the provision of appropriate non-medical services.
Finds resources and services in the community that support members independence and wellness.

Monitors the outcomes of the developed community care plan.

Acts as a liaison between the SCO and many ASAP disciplines.

Participates in the organization and promotion of health-related programs and activities.

Attends Primary Care Team meetings and Member Discharge Meetings as required.

Participates in Team meetings, Managed Care Clinical Meeting, Managed Care Staff Meetings, and activities as a team member.
Work collaboratively within the team when difficult scenarios and issues arise within a teammate's caseload.

Other duties as assigned by Managed Care Program Manager

Qualifications: BA/BS in social work, human services or related field required; experience with Elders in a Health Care setting preferred; Strong written, verbal, computer and skills necessary to work successfully in an interdisciplinary team required. Must have valid Driver's License and reliable transportation. Bilingual in Khmer is essential

Hours: 37.5 hours/week
AA/EOE