Job Listing
Social Worker
Veterans Health Administration · Posted 6 days ago
About the Role
Social Workers within the Patient Aligned Care Team (PACT) model serve as integral care team members, functioning as care coordinators for an assigned panel of Veterans. They are responsible for assessing and addressing a broad spectrum of biopsychosocial needs that influence health outcomes, including mental health, housing instability, financial hardship, caregiver burden, food insecurity, and access to community resources.
What You'll Do
- →The Patient Aligned Care Team (PACT) is a comprehensive, interdisciplinary model designed to provide longitudinal, Veteran-centered primary care with an emphasis on prevention, health promotion, chronic disease management, and care coordination.
- →Within this framework, the social worker functions as an essential care coordinator for an assigned panel of Veterans, ensuring that care aligns with each Veteran's individual needs, goals, and values.
- →Social workers apply advanced clinical skills, and a holistic perspective rooted in the person-in-environment framework to address the full spectrum of biopsychosocial factors influencing Veteran health outcomes.
- →Must have a high level of skill and expertise to establish and maintain effective therapeutic relationships with Veterans in the Primary Care Clinic and/or their families.
- →The incumbent can independently work with Veterans and their families who are experiencing a wide range of complicated medical, psychiatric, emotional, behavioral, financial, legal, and psychosocial problems.
- →Effective social work in the Patient Aligned Care Team context often occurs over a series of several visits and may involve the need of the social worker to visit the Veteran in their home.
- →Independently complete comprehensive, strengths-based psychosocial assessments, incorporating Veteran self-identified concerns and the impact of family, community, housing, and environmental factors.
- →Assess and monitor changes in psychosocial functioning, financial status, housing, food security, and caregiver burden, updating assessments as clinically indicated.
- →Provide case management services across the continuum of care, including coordination of medical, mental health, and community-based services.
- →Apply knowledge of human development across the lifespan to address issues of disability, terminal illness, loss, and grief.
- →Serve as an active member of the interdisciplinary PACT team, collaborating with primary care providers, nurses, pharmacists, behavioral health staff, and specialty Social Workers to develop and implement person-centered care plans.
- →Provide ongoing consultation to team members regarding psychosocial barriers to care and facilitate problem-solving strategies to promote treatment engagement and adherence.
- →Implement evidence-based treatment modalities and therapeutic interventions as appropriate, including psychoeducation, supportive counseling, crisis intervention, and behavioral activation strategies.
- →Conduct diagnostic assessments and psychotherapy under the supervision of an LCSW supervisor, as appropriate to level of licensure.
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.
Personality Fit
Job ID: 16e0e9a7-2ca0-4b0c-b53b-93cffa3bbe8e
Posted via USAJobs