Social Worker (PACT)

The Social Worker (PACT) has responsibility for the provision of social work within assigned segments of the Patient Aligned Care Team (PACT). PACT is a comprehensive team which delivers 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 in this Veteran-Centric approach often functions as a care coordinator.

Major duties include, but are not limited to: Assessment of psychosocial problems. Complete thorough assessments to determine the presenting problem, to determine in-home factors impacting the problem, and to determine obstacles to treatment and/or follow through with recommended treatments. Case management with members of the outpatient interdisciplinary team. Participate in scheduled interdisciplinary team huddles as a method of identifying those Veterans that may "be at risk" and require psychosocial intervention to reduce overall impact of risk. Help the patient and family to understand the contributing factors to the problem(s), will discuss with them the pros and cons of possible short-term and long-term solutions, encouraging them to make positive and lasting changes to reduce stressors. Coordinate a collaborative effort to meet the agreed upon goals for a Veteran's treatment needs and include liaison with community professionals regarding needed services for Veterans and/or their families. Services include but are not limited to interventions/referrals to increase access to care, transportation assistance, Advanced Directives, economic assistance, housing assistance for the patient's level of need (affordable independent housing, homeless shelters, group and family care homes, Veterans Homes, assisted living, nursing homes, respite care, hospice care) and necessary services to assist with functional decline. Establish and maintain effective therapeutic relationships with Veterans in the Primary Care Clinic and/or their families. Complete thorough psychosocial assessments to determine the psychosocial functioning and needs of Veterans and/or their families. Facilitate action for 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. Community placements can involve but are not limited to referrals to contract nursing homes, Community Living Centers, residential care homes, inpatient and outpatient hospice services. Utilize telehealth modalities to best meet Veteran needs. Provide consultation and education to Veterans and their families regarding community resources, VA benefits and specialty programs, and Advance Directives. Serve on committees, work groups, and task forces at the facility as deemed appropriate by the supervisor and Chief of Social Work Services. Attend all appropriate staff meetings to include, but not limited to, interdisciplinary treatment team meetings, Social Work team meetings, Social Work supervision meetings, and other committee and workgroups. Provide assistance with the orientation and learning of less experienced social workers. Other duties as assigned as determined by the direct supervisor, Chief of Social Work Service and/or the Executive Leadership Team of the Battle Creek VA Medical Center. Work Schedule: Monday-Friday 8:00am-4:30pm Telework: Not Available Virtual: This is not a virtual position. Functional Statement #: 93562-A Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

You must be a U.S. Citizen to apply for this job. To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Selective Service Registration is required for males born after 12/31/1959. Must be proficient in written and spoken English. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Complete all application requirements detailed in the "Required Documents" section of this announcement. As a condition of employment for accepting this position, you will be required to serve a 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

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/.