Social Worker

About the role

The incumbent provides comprehensive psychosocial assessment, triage, and case management services to Veterans currently referred to Specialty Care through Care in the Community. The Social Worker will provide a clinical assessment and act as a liaison; coordinate with Veterans referred to specialty care through Care in the Community; coordinate necessary services for discharge planning; and assess Veterans' and caregivers' needs via telephone assessments.

Responsibilities

• Provide comprehensive psychosocial assessment, triage and case management services to Veterans currently referred to Specialty Care through Care in the Community.
• Cookordinate with Veterans referred to specialty care through Care in the Community, coordinating needed services for discharge planning and assessing Veteran and caregiver needs via telephone assessments.
• Provide clinical assessment and act as a liaison, insuring Care in the Community Veterans are able to connect with required services through the local V AMC if desired.
• Continuously assesses and monitors the psychosocial needs, discharge plan and follow up needs for Veteran's currently referred to Community Care specialty services.
• Provide support, assessment, and appropriate interventions (case management) for Veterans that require continued case management due to limited supports and resources.
• Manage, coordinate and provision of Social Work services to Veterans and their families as well as community vendors.

Requirements

• Must have a current, valid, unrestricted driver's license and the ability to operate a GSA vehicle for outreach activities.
• Independently complete thorough initial assessments to determine the psychosocial functioning and needs of Veterans and/or their families.
• Participate as a member of the interdisciplinary treatment team by collaborating with treatment team members in the mental health clinic, primary care clinic, and inpatient units when Veterans are readmitted to the medical center for stabilization of psychiatric or medical conditions, or have been discharged to the community from an inpatient unit.
• Facilitate discharge planning through collaboration with Veterans and their families as well as community vendors, community specialty clinics, community hospitals and interdisciplinary treatment team members.
• Serve as a liaison between Veterans, their families, sponsors and VA and community resources in order to ensure thorough follow through of required services.
• Provide consultation to other treatment team and staff members as well as sponsors/vendors regarding psychosocial needs of Veterans and/or their families and the impact of the identified psychosocial problems on the Veteran's health care planning, compliance with treatment, discharge planning, and ongoing adjustment following Community Care specialty clinic treatment.
• Provide assistance with the orientation and learning of less experienced Social Workers to serve as a preceptor for Social Work students.
• Participate in a rotation of on-call Social Workers, including modification of tour of duty, to accommodate patient care needs on weekends, if needed.

Qualifications

• Have a master's degree in social work from a school of social work fully accredited by the Council on Social Work Education (CSWE).
• Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree level.
• Knowledge of community resources, how to make appropriate referrals to community and other governmental agencies for services, and ability to coordinate services.
• Skills in independently conducting psychosocial assessments and treatment interventions to a wide variety of individuals from various socio-economic, cultural, ethnic, educational and other diversified backgrounds.
• Knowledge of medical and mental health diagnoses, disabilities and treatment procedures (i.e. acute, chronic and traumatic illnesses/injuries, common medications and their effects/side effects, and medical terminology) to formulate a treatment plan.