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Social Worker- Patient Aligned Care Team
3 months ago
The incumbent must use a high level of skill in assessing, completion of treatment or service planning, service delivery/interventions and case managing complicated psychosocial problems experienced by Veterans.
Social work responsibilities include the assessment of psychosocial problems often at a time when the Veteran is experiencing crisis and include the provision of shortterm, solution focused goal planning and case management with Veterans and/or their families.
Referrals typically originate from members of the interdisciplinary team, from Veterans and/or their families presenting as walk-ins to seek assistance, and from community professionals.
Case management with members of the outpatient interdisciplinary team is provided in order to coordinate a collaborative effort to meet the agreed upon goals for a Veteran's treatment needs.
Services include, but are not limited to, homelessness, hospice services, nursing home care, home health services, financial resources, VA benefits, and transportation services.
Clinical Functions:
The incumbent:
Must have a high level of skill and expertise to establish and maintain effective therapeutic relationships with Veterans in the Primary Care Clinic and their families.
Able to independently work with Veterans who are experiencing a wide range of complicated medical, psychiatric, emotional, behavioral, financial, legal and psychosocial problems.
Must have knowledge of the Patient Aligned Care Team (PACT) approach and the role of each health and allied health care team members.
Must independently complete thorough psychosocial assessments to determine the psychosocial functioning and needs of Veterans. Is able to assess functional acuity of the patient and provide appropriate interventions.Must actively participate as a member of the interdisciplinary treatment team and actively participate through collaboration with Veterans and family as well as other team members in the development and implementation of treatment goals and interventions.
Must possess a working knowledge and experience in use of medical and mental health diagnoses, disabilities, and treatment procedures, including acute, chronic and traumatic illnesses, substance abuse disorders, common medications and their effects/side effects, and medical terminology.
Must facilitate action for community placements through collaboration with Veterans as well as interdisciplinary treatment team members.Must have an understanding of caregiver stressors, ability to conduct caregiver assessment and provide appropriate caregiver specific interventions.
Must serve as a liaison between Veterans and/or their families and VA and community resources.
Must possess knowledge and ability to independently implement treatment modalities and evidence-based practices as well as provide educational classes, and supportive groups for Veterans and families.
Must be able to use and teach Veterans in the effective use of the My HealtheVet (MHV) system. Must possess skill in using computer systems.Must provide consultation and education to Veterans and their families regarding community resources, VA benefits and specialty programs, and Advance Directives.
Must be available to provide consultation to other treatment team and staff members regarding psychosocial needs of Veterans and their families and the impact of the identified psychosocial problems on the Veteran's health care planning and compliance with treatment.
Must maintain knowledge of Veteran's benefits and services, community resources, and process for making appropriate referrals to community and other governmental programs or agencies.
Travel up to 25% of the time is a regular part of the position and the incumbent must be able to pass a driver physical from the VA and qualify to operate government vehicles.
Work Schedule:
Monday-Friday, 8:00am- 4:30pm
Telework:
Ad-hoc with Supervisor approval.
Recruitment/ Relocation Incentive (Sign-on Bonus): Not Authorized.
EDRP Authorized:
Contact for questions/assistance.
Pay:
Competitive salary and regular salary increases
Paid Time Off: 37-50 days of annual paid time offer per year days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience
Retirement:
Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA
Insurance:
Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)
Permanent Change of Station (PCS):
Not Authorized
PCS Appraised Financial Disclosure Report:
Not required
