Social Worker, Community Health

Overview

This position provides services to veterans in the Community Living Center (CLC). The social worker is involved in discharge planning, case management, advocacy, providing psychosocial education, and coordinating linkages with appropriate VA and community service providers/agencies as needed by the client. CLC social workers are also assigned duties assisting other program areas, as needed to assist the organization and ensure workload targets are met.

• Screening/Assessment
  The CLC social worker independently completes psychosocial assessments with veterans. The goal of the assessment is to highlight the veterans  strengths, limitations, internal and external supports and service needs in order to optimize the veteran s functional status and safely maintain the veteran in his/her home or community living setting.
• Case Management/Goal Setting/Discharge Planning
  The CLC Social Worker provides case management services to veterans, serving as the liaison to other treatment programs. The CLC Social Workers engage veterans and, when appropriate, other members of the veteran s support system, in an ongoing information-gathering and decision-making process to help the veteran identify goals, strengths, and challenges.
• Treatment/Interventions
  The CLC Social Worker identifies needed psychosocial interventions, care coordination, case management, supportive counseling and/or brief psychotherapy services within the bounds of their level of licensure, as needed. The incumbent coordinates care with other healthcare professionals, including but not limited to physicians, psychiatrists, nurses, chaplains, pharmacists, physical, occupational and recreation therapists; and other social workers, as well as other VA, government, and community programs.
• Resources and Referrals
  Develops a resource file of VA and community social service programs. Finds a suitable means of treatment to help veterans and/or significant others. Based upon veterans needs and eligibility, facilitates and/or coordinates VA and community-based services and referrals. Collaborates with other service providers in reassessing the veterans needs, educating the veteran and/or caregiver of the available services and assisting them in establishing the appropriate referrals based on the veteran preference or that of his/her surrogate decision-maker.
• Advocacy
  Acts as an advocate when it serves the best interest of the veteran/family. When appropriate and feasible, conducts education and encourages the veteran/family to advocate on own behalf, thus fostering a sense of independence and empowerment.
• Patient Education
  Provides education related to the veteran s VA entitlements, eligibility, services and programs, as well as community resources for medical and mental health needs. Educates and refers the veteran and as appropriate, veteran s family, caregiver and/or significant other, to the appropriate program, interdisciplinary team members, internal programs, or external programs for identified education needs. Identifies the social determinants of health education needs of veterans;
  
  and works with the interdisciplinary team members on a plan to address those needs.
• Education/Training/Supervision
  Participates in the orientation of new social work staff and other interdisciplinary team members, as assigned by supervisor. When approved by the Social Work Supervisor, social worker supervises social work students and provides a training experience in social work. Works with students to develop training plans and goals.
• Coordination of Non-Institutional and Institutional Services
  The CLC social worker coordinates referrals/consults for non-institutional and institutional services, both internally and externally, to include but not limited to HBPC, community nursing homes, ADHC/CNH, hospice, transitional and supportive housing, skilled and non-skilled homecare services in collaboration with the interdisciplinary team members.
• Administrative Responsibilities
  Incumbent documents all social work case activities in the electronic health record and other programs as directed by the social work supervisor. Submits written and/or electronic data and reports promptly and accurately per policy and/or procedures set by Social Work Service, the Medical Center, VISN, VA Central Office and other entities, as appropriate.

Monday - Friday, 8:00am to 4:30pm

• Recruitment Incentive (Sign-on Bonus):
  Not Authorized
• Permanent Change of Station (Relocation Assistance):
  Not Authorized
• Pay:
  Competitive salary and regular salary increases
• Paid Time Off: 13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year
• Parental Leave:
  After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child.
• Child Care Subsidy:
  After 60 days of employment, full time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total…