Summary
The Patient Aligned Care Team (PACT) Senior Social Worker participates in the Primary Care Clinic at Sierra Nevada VA Health Care System (VASNHCS) and Community Based Outpatient Clinics (CBOC).
Duties
VA Careers - Social Work: https://youtube.com/embed/enRhz_ua_UU Major duties include but not limited to: Represent the VA with professionalism and respect to both internal and external stakeholders. Act as a subject matter expert on VA and/or community resources. Collaborate with other service providers in assessing the Veteran's needs as appropriate. Work closely and coordinate with other PACT Social Workers in the health care system along with providing consultation and education to VA staff and community-based service providers including medical residents and social work students. Educate Veterans and/or caregiver of the available services and assisting them in establishing the appropriate referrals based on the Veteran's preference or that of their authorized surrogate decisionmaker. Utilize current VA and community social service programs and enhancing the content to the benefit of Veterans. Serve as a liaison with community agencies, assist Veterans (or caregivers) with referrals for services from community and government agencies, and help coordinate these services, when appropriate. Coordinate with other VA staff and community agencies to assist in problem solving as needed. Run psychoeducational groups for Veterans, caregivers and/or family members. Function as an independent provider within the PACT. Act as a care coordinator and case manager for psychosocial concerns related to psychosocial determinants of health for Veterans assigned to their panel. Conduct psychosocial assessments in collaboration with the interdisciplinary treatment team, the Veteran patient, family members and significant others; interviewing Veterans and family members/significant others and writing the psychosocial assessment. Ensure biopsychosocial assessments highlight Veterans' strengths, limitations, and internal/external supports and service needs to optimize their functional status. Assess and treat the complicated psychosocial and behavioral health problems of Veterans, caregivers and their families/significant others. Assess, treat, and appropriately refer for the psychosocial problems that cause distress, which often impact the health condition and create barriers to care. These stressors can include adjustment to the current medical condition, untreated or under-treated mental health or substance abuse condition, economic instability, legal problems, and inadequate housing and transportation. Accept referrals from any member of the interdisciplinary team, Veterans, caregivers and/or family members who call or walk-in for assistance, and from community professionals. Complete comprehensive psychosocial assessments for patients to help determine what psychosocial and mental health services are needed and make appropriate referrals as outlined by medical center policy. Develop treatment plans in collaboration with the Veteran/family/caregiver, interdisciplinary treatment team, and appropriate community partners. Incumbent provides psychosocial interventions and measures outcomes to interventions. Provide therapeutic services to individuals, families, and groups covering a wide variety of psychosocial issues. Work closely with Primary Care Mental Health Integration (PCMHI) clinicians to facilitate assessments and referrals and will defer to specialty Mental Health psychotherapists when brief psychotherapy is not clinically indicated or when it is more clinically appropriate to refer to specialty Mental Health psychotherapists. Coordinate with PCMHI and/or specialty Mental Health clinicians after these referrals are made to ensure a continuity of care between the PACT and the Mental Health teams. Conduct psychosocial and behavioral health assessments in collaboration with the interdisciplinary treatment team, the Veteran, family members and significant others (as appropriate). Utilize a range of psychoeducation and psychotherapeutic treatment options based on Veteran needs and clinical appropriateness to address issues related to physical limitations, psychological needs and age associated illnesses and conditions. Conduct applicable clinical reminders within their approved scope of practice or clinical privileges. Work Schedule: 8:00am - 4:30pm Monday - Friday Telework: This position is eligible for telework on an Ad- Hoc Basis Functional Statement #: 08200-F
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.
Education
Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
How you will be evaluated
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, resume, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position. It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment. Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.