Job Listing
Social Worker- Home Based Primary Care
Veterans Health Administration · Posted 56 days ago
About the Role
The position is for a Home-based Primary Care Social Worker with the Aleda E Lutz Medical Center at the Outpatient Clinic in Traverse City. The incumbent has the ability to serve veterans who are in need of community services in their home. The incumbent identifies psychosocial problems, provides treatment, which may include family counseling, long term care and advanced care planning, non- pharmacological pain interventions, and grief and bereavement counseling.
What You'll Do
- →Total Rewards of a Allied Health Professional Duties may include but are not limited to: The social worker will develop an assessment of the veteran in collaboration with the interdisciplinary treatment team, the veteran, family members and significant others, when appropriate.
- →The goal of the assessment is to highlight the veteran's strengths, limitations, and internal/external supports as well as service needs in order to optimize the veteran's functional status and safely maintain the veteran in his/her home.
- →Developing the treatment plan and setting achievable treatment goals with the veteran/family in collaboration with the HBPC interdisciplinary treatment team.
- →The social worker will include psychosocial problems in the interdisciplinary treatment plan and will attend weekly interdisciplinary care planning meetings.
- →Ongoing assessments and updating treatment plans are done, when necessary, minimally every 90 days, as health status changes.
- →Social workers will address the unique needs of Veterans who are homebound, frail, experiencing disabling and chronic health concerns, and/or are at end of life.
- →The social worker is the subject matter expert on VA and/or community resources.
- →The social worker will collaborate with other service providers in reassessing the veteran's needs for non-institutional, institutional services/programs and entitlements.
- →Responsible for educating the veteran and/or caregiver of the available services and assisting them in establishing the appropriate referrals based on the veteran's preference or that of his/her surrogate decision-maker.
- →Responsible for developing a resource file of VA and community social service programs and will refer the veteran to needed services.
- →Provide education related to VA and community resources, entitlements, Advance Directives/Living Will and will refer veterans/families to the appropriate interdisciplinary team member for identified health education needs.
- →Coordination of non-institutional and institutional services- The social worker is responsible for the coordination of referrals to non-institutional services such as HBPC, ADHC/CADHC, home hospice, skilled and non-skilled homecare services in collaboration with the interdisciplinary treatment team members.
- →Educate the veteran, their families and the team on all options available to them and will collaborate with the veteran and family on identifying preferred service.
- →The social worker may be required to do monitoring visits at area Adult Day Health Cares and/or Contract Nursing Homes.
Requirements
- ✓You must be a U.S.
- ✓Citizen to apply for this job.
- ✓Selective Service Registration is required for males born after 12/31/1959.
- ✓Must be proficient in written and spoken English.
- ✓Subject to background/security investigation.
- ✓Selected applicants will be required to complete an online onboarding process.
- ✓Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents).
- ✓Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
- ✓Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
- ✓Complete all application requirements detailed in the "Required Documents" section of this announcement.
- ✓As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest.
- ✓In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service.
- ✓Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
- ✓Note: Only education or degrees recognized by the U.S.
Personality Fit
Job ID: 0c6c5c0e-220f-433a-9142-07673d1b08ed
Posted via USAJobs