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The Patient Aligned Care Team Social Worker provides 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. The social worker functions as a PACT member with a panel of veterans to ensure that health care meets their needs, as defined by the veteran. The social worker is assigned to Primary Care and covers Urgent Care and Specialty Clinics as well, where appropriate.
03/20/2025 to 04/09/2025
$87,026 - $136,874 per year
GS 9 - 11
1 vacancy in the following location:
No
Yes—as determined by the agency policy.
25% or less - You may be expected to travel for this position.
No
Permanent
Full-time
Competitive
11
No
No
CBSW-12707512-25-MMR
833960700
The Social Worker provides care to veterans and their families who are experiencing a wide range of complicated medical, psychiatric, emotional, behavioral, and psychosocial problems. Establishes and maintains effective therapeutic relationships with, and assesses and treats the complicated psychosocial problems of, veterans and their families. Provides psychosocial care of medically complex patients and offers consultation to colleagues and students on the psychosocial treatment and care coordination of complex patients.
The Social Worker possesses advance skills and knowledge of medical and mental health diagnoses, disabilities, and treatment procedures, including acute, chronic and traumatic illnesses, substance abuse disorders, bereavement, common medications, and general medical terminology. Participates as a member of the interdisciplinary treatment team to formulate and implement treatment plans identifying the patients' problems, strengths, weaknesses, coping skills and any assistance needed. Receives referrals from any member of the interdisciplinary team, from veterans and/or their families who call or walk-in for assistance, and from community professionals. Conducts thorough assessments to determine psychosocial problems that cause distress, often impacting the health condition and creating barriers to care needs of veterans and family members, the underlying causes of the presenting problem, the interpersonal and environmental factors impacting the problem, and its effect on the patient's ability and desire to comply with the treatment recommendations by the multidisciplinary team. These stressors can include adjustment to the current medical condition, untreated or under-treated mental health or substance abuse conditions, economic instability, legal problems, and inadequate housing and transportation. Provides consultation and education to veterans and their families regarding community resources, VA benefits and specialty programs, and advance directives. This requires knowledge of the process for accessing and/or coordinating community-based services, including information and referral for additional services from other VA programs, other government programs, and community programs as well as community agencies that are covered by Medicare, Medi-Cal, and VA pay to ensure veterans receive the services they need with the least amount of financial burden. Helps the veterans and families understand the contributing factors to problems and discusses with them the pros and cons of possible short-term and long-term solutions while encouraging them to make positive and lasting changes to reduce stressors.
The PACT Social Worker provides wellness/prevention education and stress management, which includes knowledge in Whole Health, facilitates patient/family support groups, and participates in shared medical appointments as appropriate. Assists veterans and their families with coping and dealing with the loss and grief experiences in disability, terminal illness, and death. Provides case management interventions for veterans with members of the interdisciplinary team to coordinate a collaborative effort to meet the agreed upon goals for veterans' treatment needs. Facilitates community placements through collaboration with veterans and their families as well as interdisciplinary treatment team members to ensure that appropriate community placements are completed in a timely manner. Serves as a liaison between veterans, their families, the VA, and community resources in order to ensure thorough delivery of services. Represents the VA in the community by preparing presentations for community hospitals and community providers groups.
Work Schedule: Monday-Friday, 8am-4:30pm.
Compressed/Flexible: Not available
Telework: Not Available
Virtual: This is not a virtual position.
Functional Statement #: 000000
Relocation/Recruitment Incentives: Not Authorized
IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.
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: http://ope.ed.gov/accreditation/. 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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
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.
You will be evaluated for this job based on how well you meet the qualifications above.
You will be evaluated for this job based on how well you meet the qualifications above.
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, resume, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position. It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.
Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.
To apply for this position, you must provide a complete Application Package which includes:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 03/13/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12705168.
Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/job/833960700. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.