Social Worker

Quick Facts

• Role: Home Based Primary Care (HBPC) Social Worker

• Team: Interdisciplinary clinical team

• Focus: Clinical case management and psychosocial support for outpatient, home-bound Veterans

• Work schedule: 8:00 am–4:30 pm, Monday–Friday

Description

The HBPC Social Worker provides in-home psychosocial assessments and clinical case management for Veterans and their caregivers. You will identify psychosocial issues, evaluate risk and acuity (including crisis situations), and implement interventions through a psychosocial plan of care. The role also includes coordination of VA and community resources and education regarding VA benefits and programs.

Responsibilities

• Conduct comprehensive initial and follow-up in-home psychosocial assessments (when clinically indicated or at least annually) for patients, caregivers, and support systems

• Identify psychosocial issues affecting outcomes and implement interventions and social work case management aligned to goals of care

• Apply knowledge of medical and mental health diagnoses, disabilities, and treatment procedures, including common medications and non-pharmacological pain interventions

• Use knowledge of social determinants of health to assess need and risk

• Assess acuteness of need for psychosocial intervention for high-risk situations (e.g., suicide, intimate partner violence, adult abuse/neglect, food insecurity, homelessness, terminal illness, competency/guardianship)

• Coordinate adaptive equipment needs with the interdisciplinary team

• Develop a psychosocial plan of care (e.g., counseling, long-term/advance care planning, stress management, caregiver respite, psycho-educational programs, grief and bereavement support)

• Facilitate access to VA and community resources (housing, in-home assistance, financial support)

• Provide crisis intervention and develop crisis management plans to return Veterans to homeostasis

• Provide consultation and education to Veterans and families about VA/community resources, VA benefits, specialty programs, and advanced directives

Requirements

• U.S. citizenship

• Proficiency in written and spoken English

• Background/security investigation required

• Valid driver’s license; pass pre-employment physical examination

• Seasonal influenza vaccination participation required

• Master’s degree in Social Work from a CSWE-accredited school

• State licensure or certification to independently practice social work at the master’s level (VHA may waive at the GS-9 level pending prerequisites)

• Demonstrated KSAs: Veteran-centric interventions and counseling; psychosocial assessment and treatment plan formulation; ability to implement supportive/problem-solving/crisis techniques; effective communication and relationship building; foundational knowledge of medical/mental health diagnoses, medications (effects/side effects), and medical terminology

Benefits

• Competitive salary with regular salary increases

• Paid Time Off: 37–50 days annual paid time off per year (annual leave, sick leave, and federal holidays)

• Parental leave (up to 12 weeks paid after 12 months of employment)

• Child care subsidy eligibility based on income and tenure

• Retirement: federal pension (5 years vesting) and federal 401K with up to 5% contributions

• Insurance: federal health/vision/dental/term life/long-term care coverage options