This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appointment. Approval, award amount (up to $200,000) and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Learn more The Senior Social Worker (PACT) provides clinical psychosocial and case management services at an advanced practice level to eligible active duty service members, Veterans and their family members to meet biological, psychological, social, and environmental needs. Services are provided at the Charles Wilson (Lufkin) Community Based Outpatient Clinic, in the community, virtually and via telework. In addition, incumbent may provide virtual coverage to other CBOC locations within the Michael E. DeBakey VA Medical Center (MEDVAMC) catchment area. Specific duties include, but are not limited to, the following: Incumbent will provide high quality medical social work care and services to Veterans enrolled in outpatient Primary Care. This includes active case management and care coordination, clinical assessment and treatment, advocacy, and coordination of linkages to other appropriate VA or community service providers/agencies as needed by the Veteran and family. Incumbent often functions as a care coordinator with a panel of Veterans to ensure that their health care needs are met. Incumbent incorporates complex multiple causation in differential diagnosis and treatment of Veterans, including psychosocial and psychiatric diagnoses within approved clinical privileges and scope of practice. Incumbent is able to provide individual, group, and family psychotherapy and advanced level case management interventions used in the treatment of Veterans. Specifically, the incumbent also facilitates and/or participates as an interdisciplinary team member in health promotion, behavioral, and psychoeducational groups with a focus on chronic illness (i.e. smoking cessation, diabetes, weight management). Promote and utilize group, individual and phone education to complete Advance Care Planning (ACP) in the PACT clinic. Provides guidance and counseling for Veterans/families with regard to long term care and end of life care/decisions. Incumbent coordinates with outside medical facilities to promote continuity of care to include: creation of a network of social services providers in the local community to enhance services provided by the VA; fill service gaps identified in the Veteran's care and treatment due to limitations in Veteran's services. Functions within the interdisciplinary team to coordinate with medical staff re: home health care and extended care referrals. Collaborates with social work, Rehab and Long Term Care, Primary Care, and nursing service to facilitate acute rehabilitation admission, transfer to a skilled nursing facility, initiation or resumption of skilled or nonskilled homemaker/home health services, respite, and/or referral to other VA and/or community programs. Provides care coordination and consultation with medical, nursing, and social work staff in other care areas to which Veterans are referred, consulted, treated and/or co-managed. Provides assessment, evaluation, treatment, and reporting for cases of suspected or reported abuse, neglect, or financial exploitation. Maintains knowledge of Veteran's benefits and services, community resources, and process for making appropriate referrals to community and other governmental programs or agencies. Develops and implements methods for measuring effectiveness of social work practice and services in specialty areas, utilizing outcome evaluations to improve treatment services. Incumbent is able to demonstrate the ability to design changes based on empirical findings. Offers consultation to colleagues and students on the psychosocial treatment of patients treated in specialty areas, rendering professional opinions based on experience and expertise and role modeling effective social work practice skills. Remains abreast of national, regional and local treatment trends related to patient populations and geographical specific issues. Demonstrates the ability to teach and mentor staff and students in the special area of practice and to provide supervision for licensure or specialty certifications. Responsible for clinical program development and is accountable for clinical program effectiveness and modification of service patterns. Evaluate and enhance the quality of service provided to Veterans by developing and implementing systems to monitor and improve services and delivery. Work Schedule: Monday through Friday; 8:00 am to 4:30 pm; with possible extended hours based on patient needs Financial Disclosure Report: Not required
Internal Number: 596720400
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.