Social Worker-Home Based Primary Care (HBPC) - Veterans Affairs, Veterans Health Administration : Job Details

Summary This position is responsible for assessment, planning, and provision of case management services in Home Based Primary Care (HBPC). This Social Worker coordinates a variety of activities including outreach, interdisciplinary activities, psychosocial assessments, treatment planning, consultation/education to staff and community based service providers. Responsibilities VA Careers - Social Work: Total-Rewards-of-an-Allied-Health-VA-Career-Brochure.pdf Social Work: vacareers.va.gov/wp-content/uploads/sites/5/Total-Rewards-of-a-Social-Worker-Career-Flyer.pdf Duties include but are not limited to the following: This position collaborates with applicable VA services lines and/or services for Community Nursing Home authorizations, durable medical equipment (DME) and rehabilitation requirements. This position assists in the screening and coordination of referrals to the Community Nursing Home programs. Will provide support for the coordinator of the Community / Contract Nursing Home Coordinator to include verifying eligibility for services. The patients for whom the incumbent regularly provides treatment services have a wide range of health care problems including acute and chronic, severe and debilitating conditions, physical and psychiatric conditions, substance abuse or homelessness. Incumbent employs a full range of social work treatment modalities with individuals, families and groups with appropriate regard for the complexity of a given problem as assigned; he/she provides services at any and all points on the continuum of care The incumbent provides psychosocial and case management services at an independent practice level and provides linkage to VA and community resources. The incumbent conducts psychosocial assessments The incumbent conducts interviews or observes the patient to assess emotional, functional or psychological condition. The incumbent employs professional processes in using interview, observation, personal histories and other measurement devices in the assessment of a diverse group of clients. The incumbent develops treatment interventions including but not exclusively, crisis intervention, social work case management, education on Advance Directives, grief counseling, guidance, advocacy, supportive counseling, recovery focused counseling and other treatment approaches that may be necessary. He/she utilizes knowledge of family dynamics, developmental theory and interpersonal relationships and system approach to care. The incumbent coordinates community-based services. Information, referral, and linkage services for both veteran and family members are provided, including VA resources and benefits and non-VA resources and benefits. The incumbent identifies high-risk patients and provides case management services as appropriate. The incumbent screens and coordinates referrals to the Community nursing home program. The incumbent collaborates with applicable VA service lines and/or services for authorizations, durable medical equipment, rehabilitative requirements, authorizations, and fiscal management of the program The incumbent acts as liaison and coordinator for specialty care requests for Veterans within community nursing home program The incumbent participates in interdisciplinary team to ensure Veterans care needs are met and continue to require nursing home level of care. The incumbent participates in discharge planning for Veterans as needed The incumbent oversees placement of Veterans in the CNH and complete required routine visits The incumbent provides outreach and education to grow referral sources for community adult day health care agencies and community nursing homes The incumbent provides crisis intervention for veterans in financial crisis, emotional crisis due to physical or psychiatric conditions, and crises necessitated by a marked change in lifestyle, changes in functioning or environment or social situations. Driving is required for this position Work Schedule: 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: 37-50 days of annual paid time offer per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience. 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 eligible childcare costs for eligible children up to the monthly maximum of $416.66. Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Telework: Emergency Ad Hoc Telework May Be Authorized Virtual: This is not a virtual position. Functional Statement #: 000000 Permanent Change of Station (PCS): Not Authorized Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job. Selective Service Registration is required for males born after 12/31/1959. Must be proficient in written and spoken English. You may be required to serve a probationary period Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Must pass pre-employment driving physical examination. Must possess a valid driver's license and a clean driving record report from the DMV. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See Additional Information below for details. Qualifications 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: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. 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 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 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. At the time of appointment, the supervisor, chief social work or social work executive will provide the unlicensed/uncertified social worker with the written requirements for licensure or certification, including the time by which the license or certification must be obtained and the consequences for not becoming licensed or certified by the deadline.] For appointments at the GS-9 grade level, VHA social workers who are not licensed or certified at the time of appointment must become licensed or certified at the independent, master's level within three years of their appointment as asocial worker. Physical Requirements. See VA Directive and Handbook 5019, Employee Occupational Health Services. English Language Proficiency. Candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. § 7403(f). May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Grade Determinations: In addition to the basic requirements for employment, the following criteria must be met when determining the grade of candidates. Social Worker, GS-9 Experience, Education, and Licensure. None beyond the basic requirements. Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs: Ability to work with Veterans and family members from various socio economic, 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. Social Worker, GS-11 Experience and Licensure. Appointment to the GS-11 grade level requires completion of a minimum of one year of post-MSW experience equivalent to the GS-9grade level in the field of health care or other social work-related settings, (VA or non-VA experience) and licensure or certification in a state at the independent practice level. NOTE: For appointment licensure or certification at this level please refer to paragraph 3c. 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. 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. Preferred Experience: Home Health Experience Preferred Reference: For more information on this qualification standard, please visit 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. Physical Requirements: You will be asked to participate in a pre-employment examination or evaluation as part of the pre-employment process for this position. Questions about physical demands or environmental factors may be addressed at the time of evaluation or examination. Daily intermittent walking, standing, bending, stooping, reaching, and carrying of lightweight items required. Rigid deadlines and need for high degree of accuracy periodically becomes stressful. Driving is required for this position. A portion of the work is performed outside the VA Health Care setting (including CBOC), where the environment cannot be controlled. Education IMPORTANT: A transcript must be submitted with your application Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: Additional Information The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being. Receiving Service Credit or Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions. This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.