Responsibilities

• Performs in-home and telephone assessments of SNP participants as required by state and program policy.
• Maintains knowledge of governmental and private organizations and resources in the community to refer clients to in order to assist them in meeting financial, psychological, emergency care, emotional, or other needs.
• Stays abreast of social work theory, techniques and practices, individual and group behavior, social problems, the aging process, medical and mental illness, family dynamics, coping behavior, crisis intervention, and treatment of various medical and mental diseases and social issues.
• Routinely talks with clients identified through a screening process as high risk on the phone.
• Answer phone calls from clients and/or their family members regarding inquires on meal service and/ or available resources.
• Documents direct client interactions, services development, and referrals in accordance with agency requirements. Maintains case data and documentation through various computer programs.
• Serves as inter/multi-disciplinary team member.
• Delivers meals to homebound participants as needed.
• Performs other related duties as assigned.