This Social Worker is assigned to the Patient Aligned Care Teams (PACT) at the Community Based Outreach Clinics (CBOC) in Grants Pass, OR. They are responsible to provide direct services to adult and geriatric Veterans and related assistance to their families and/or caregivers; this includes assessment, planning, and provision of Social Work services in conjunction with Primary Care Teams (PACT) at the CBOC clinic. As a member of the Interdisciplinary Treatment Team with PACT, the Social Worker conducts work activities independently using his/her educational training, clinical experience, VA policies, and JCAHO standards in administering direct services: psychosocial assessment of patient/family needs in relation to the provision of interdisciplinary treatment planning and service delivery; individual, group, and family counseling and casework services for the purpose of addressing identified needs. The incumbent is responsible for completing the following duties/responsibilities: a. The incumbent will conduct psychosocial assessments to determine needs of Veterans and family members. b. The incumbent is an active participant in the treatment planning process with other healthcare disciplines. c. The incumbent will participate in discharge planning with other disciplines and will be responsible for ensuring that discharge plans are executed in a manner that is timely and appropriate. d. The incumbent will provide individual, family and group counseling as appropriate. e. The incumbent will provide consultation/education to Veterans and families on community resources, advance directives and VA benefits. f. The incumbent will act as a consultant to other team/staff members. g. The incumbent will provide consultation/education to medical residents and interns on social work practice and VA policy and procedure. h. The incumbent will act as liaison between VA and community resources, to include marketing and public relation duties as needed. i. The incumbent will provide clinical case management to Veterans and families, as needed, throughout the continuum of care. j. The incumbent will provide a full range of social work services within commonly accepted standards of social work practice which includes case work, individual, family and group counseling, discharge planning, clinical case management and other services as appropriate. k. The incumbent will address Advance Directives, and related end-of-life care issues, in accordance with the standards of their work area. l. The incumbent will provide wellness/prevention education and facilitate Patient/family support groups as appropriate. m. The incumbent will as appropriate, supervise the practice of social work students, or a less experienced social worker towards licensure. n. The incumbent will coordinate treatment and communicate with the care lines to facilitate continuity of care for Veterans. o. The incumbent will participate in committee assignments, as deemed necessary by the Supervisor or Service Manager. p. The incumbent will maintain data and statistical compilations to comply with JCAHO, VA and medical center policy and procedures. q. The incumbent will assist patients and their significant others with coping and dealing with the loss and grief experiences in disability, terminal illness and death. r. The incumbent will document social work interventions and activities in patient's clinical record utilizing CPRS and ensure appropriate hand off when transferring of patient care. s. The incumbent will operate such vehicles as sedans, station wagons, 4x4 utility, pick-up trucks or stake bed trucks weighing less than 22,000 pounds. Incumbent may drive Veterans to and from such places as clinically indicated: such as hospitals, doctor's offices, meetings and activities relevant to Veteran's Treatment Plan. May need to assist Veterans requiring special help into and out of vehicles and ensuring their safety and comfort while in this vehicle. Work Schedule: Monday-Friday, 0800-1630 Telework Clarification: Incumbent may be approved for telework; however, this is not a virtual position. On-site clinical care is required. Financial Disclosure Report: Not required
Internal Number: 599903700
About Veterans Affairs, Veterans Health Administration
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.