The Patient Aligned Care Team (PACT) Social Worker participates in the Primary Care Clinic at the VA Medical Center and at Community Based Outpatient Clinics (CBOC). The PACT is a comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus: prevention; health promotion, coordination, and chronic disease management. **This is an OPEN CONTINUOUS ANNOUNCEMENT and will remain open until 9/29/2023. The initial cut-off date for referral of eligible applications will be reviewed on 8/17/2023. Eligible applications received after that date will be referred at regular intervals or as additional vacancies occur on an as-needed basis until positions are filled.** Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: Citizenship. Be a citizen of the United States. (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3g this part). Education. Have a master's degree in social work from a school of social work fully accredited by the Council on Social Work Education (CSWE). Graduates of schools of social work that are in candidacy status do not meet this requirement until the School of Social Work is fully accredited. A doctoral degree in social work may not be substituted for the master's degree in social work. Verification of the degree can be made by going to http://www.cswe.org/Accreditation to verify that the social work degree meets the accreditation standards for a masters of social work. Licensure. 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. Current state requirements may be found by going to http://vaww.va.gov/OHRM/T38Hybrid/. Exception: VHA may waive the licensure or certification requirement for persons who are otherwise qualified, pending completion of state prerequisites for licensure/certification examinations. This exception ONLY APPLIES at the GS-9 grade level. For the GS-11 grade level and above, the candidate must be licensed or certified. English Language Proficiency: Candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. ? 7403(f). Drivers License: A valid Class D Driver's License (regular adult driver's license) is required for the position Grade Determinations: GS-9 Experience, Education, and Licensure: None beyond the basic requirements. Demonstrated Knowledge, Skills, and Abilities: The candidate must demonstrate all of the following KSAs: Ability to work with Veterans and family members from various socioeconomic, cultural, ethnic, educational, and other diversified backgrounds utilizing counseling skills. Ability to assess the psychosocial functioning and needs of Veterans and their family members, and to formulate and implement a treatment plan, identifying the Veterans problems, strengths, weaknesses, coping skills, and assistance needed. Ability to implement treatment modalities in working with individuals, families, and groups to achieve treatment goals. This requires judgment and skill in utilizing supportive, problem solving, or crisis intervention techniques. Ability to establish and maintain effective working relationships and communicate with clients, staff, and representatives of community agencies. Fundamental knowledge of medical and mental health diagnoses, disabilities, and treatment procedures. This includes acute, chronic, and traumatic illnesses/injuries; common medications and their effects/side effects; and medical terminology. GS-11 Experience: Appointment to the GS-11 grade level requires completion of a minimum of one year of post-MSW experience equivalent to the GS-9 grade level in the field of health care or other social work-related settings, (VA or non- VA experience). OR Education: In addition to meeting basic requirements, a doctoral degree in social work from a school of social work may be substituted for the required one year of professional social work experience in a clinical setting. AND Licensure: Must have licensure or certification in a state at the independent practice level. AND Demonstrated Knowledge, Skills, and Abilities: In addition to the experience above, candidates must demonstrate all of the following KSAs: Knowledge of community resources, how to make appropriate referrals to community and other governmental agencies for services, and ability to coordinate services. Skill 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. Skill in independently implementing different treatment modalities in working with individuals, families, and groups who are experiencing a variety of psychiatric, medical, and social problems to achieve treatment goals. Ability to provide consultation services to new social workers, social work graduate students, and other staff about the psychosocial needs of patients and the impact of psychosocial problems on health care and compliance with treatment. The full performance level of this vacancy is GS-11. The actual grade at which an applicant may be selected for this vacancy is in the range of GS-9 to GS-11. Preferred Experience: 1 year post-MSW experience in a medical social work setting. References: VA HANDBOOK 5005/120 PART II APPENDIX G39 Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Services. Must be in overall good health, able to sit at a desk working at a computer, engage in light to moderate physical activity including sitting, walking, bending, and carrying supplies. Social Worker must be able to perform primarily light and sedentary duties with occasionally moderate physical demands, exercise patience, and control emotions, with reasonable accommodation, if necessary, without endangering the health and safety of the social worker or others. This position requires a valid state driver's license and local travel to provide community-based care to Veterans. The position may require some travel in the community, through use of a government vehicle or other individual arrangements, to meet with representatives/stakeholders who aid and support to Veterans in clinics, medical centers, Community Clinics, etc. This position also requires close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; and repetitive motions of the wrists, hands, and/or fingers. ["VA Careers - Social Work: https://youtube.com/embed/enRhz_ua_UU Functions as a care coordinator to ensure that access to and services provided for healthcare meets the needs of the patient, as defined by the Veteran/Caregiver. Understand the person-in-situation and the influences that family and community have in impacting the healthcare needs of Veterans. Provides therapeutic services to individuals, families, and groups covering a wide variety of psychosocial issues not limited to the geriatric setting. Collaborates with interdisciplinary teams in the provision of comprehensive healthcare services to Veterans and ensures equity of access, service, and benefits to this population. Collects, develops, and analyzes data using appropriate clinical indicators and monitoring activities to assure that the care provided is of the highest quality. Provides consultation and education to VA staff and community-based service providers including medical residents and Social Work students. Documents Social Work activities and interventions in patient's clinical record utilizing the computerized patient record system (CPRS) and ensures appropriate hand-off when transferring patient care. Comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus: prevention; health promotion, coordination, and chronic disease management. Functions as an independent provider within the PACT. Must use a high level of skill in assessing and treating the complicated psychosocial and behavioral health problems of Veterans, caregivers, and their families/significant others. Responsibilities include the assessment of psychosocial problems that cause distress, which often impact the health condition and create barriers to care. These stressors can include access to appropriate care, adjustment to the current medical condition(s), untreated or under-treated mental health or substance abuse conditions, economic instability, legal problems, functional limitations, inadequate housing, and issues with transportation. Referrals typically originate from any member of the interdisciplinary team, from Veterans, their caregivers and/or family members who call or walk-in for assistance, and from community professionals. Coordinate with other VA staff and community agencies to assist in problem solving as needed. Case management with members of the outpatient interdisciplinary team is provided to coordinate a collaborative effort to meet the agreed upon goals for a Veteran's treatment needs and include liaison responsibilities with community professionals regarding needed services for Veterans and/or their families. Services include but are not limited to: interventions to increase access to care, including transportation assistance and advanced directives; economic assistance, including assistance with medical bills, financial aid services and strategies to increase income (employment, vocational rehabilitation, VA benefits, disability), and/or reduce expenses; identifying the appropriate housing for the patient's level of need (affordable independent housing, homeless shelters, group and family care homes, Veterans Homes, assisted living, nursing homes, respite care, hospice care, etc.); and assessment for necessary services to assist with functional decline. Conduct psychosocial and behavioral health 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 assessment. Demonstrates an understanding of the range of treatment and possesses skills needed for all adult patients including geriatric patients and can address issues related to their physical limitations, psychological needs and age-associated illnesses and conditions. Understand the problems of advancing age and respect for the diversification of the aging Veteran population, being sensitive to human growth and development, age-appropriate needs and concerns of the geriatric Veteran and be able to provide current and advanced practice interventions to the treatment of this Veteran population. Experience and knowledge to be able to step in and facilitate, in collaboration with the Access Crisis Team and within approved clinical privileges, in the event of a crisis onsite. Work Schedule: Monday-Friday 8:00am-4:30pm Telework: Available 3+ days per pay period Virtual: This is not a virtual position. Functional Statement #:51688A & 51687A Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required"]

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