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    Duties

    Summary

    The Senior Social Worker possesses advanced practice skills and judgment and at least two years in an area of specialized social work practice. Assigned to a remote, highly rural Community Based Outpatient Clinic with no access to on-site supervision. This includes a highly rural patient population with complex and co-occurring physical, behavioral, and psychosocial problems requiring advanced and innovative psychosocial interventions.

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    Responsibilities

    This Senior Social Worker is assigned to one of the three remote and highly rural Community Based Outpatient Clinics at Newport/Lincoln City, North Coast, or The Dalles. As part of the Rural PACT Initiative, the Senior Social Worker has the following areas of assignment: (1) ensuring the PACT model of social work care is delivered to assigned Veterans at the remote site of care, (2) utilizing the VSSC Unassigned Patient List to provide proactive outreach and case management services to facilitate Veteran enrollment for care and assignment to a PACT, (3) partnering with the Community Care Nurse Liaison Program to facilitate Veteran discharge from non-VA hospitals, (4) utilizing the VSSC Care Assessment Need (CAN) Score report to provide proactive outreach and case management services for Veterans at risk of hospitalization or death, and (5) utilizing the VSSC High Need/High Risk Veterans & HPBC Partnerships Expansion report to provide proactive outreach and case management services to facilitate Veteran enrollment with HBPC or other non-institutional care services. These program teams are located at various sites in VISN 20 and are closely associated with VAPORHCS Business Office, Primary Care, and Rehabilitation & Long Term Care. These multidisciplinary teams and clinics include medical, nursing, behavioral, and administrative staff.

    Rural PACT Initiative social work services include primary and secondary health care services, to include, but not limited to, psychosocial screening and assessment, psychosocial treatment and intervention, specialized case management and care coordination, discharge and/or after-care planning, health education and advanced health care planning, supportive counseling and caregiver support, interdisciplinary collaboration, coordination, and consultation, and administrative and professional duties. Rural PACT Initiative Senior Social Workers work closely with other members of the assigned highly rural CBOC and with members of affiliated program offices associated with the Rural PACT Initiative program goals.

    Work Schedule: 0730-1600 Monday-Friday & 0800-1630 Monday-Friday
    Financial Disclosure Report: Not required

    Travel Required

    Not required

    Supervisory status

    No

    Promotion Potential

    12

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/582854000. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.