Summary
The incumbent practices at the advanced social work level, providing both program coordination and direct clinical practice. This involves implementing, managing, and evaluating an interdisciplinary care coordination framework aimed at improving outcomes for high-need, high-risk Veterans, as well as provide comprehensive biopsychosocial assessments, intervention, treatment planning, and case management for Veterans receiving primary care through the Patient Aligned Care Team (PACT).
Duties
VA Careers - Licensed Clinical Social Worker: https://youtube.com/embed/U_xC25QsN0w Total Rewards of a Allied Health Professional The purpose of this position is to strengthen the medical center's ability to provide integrated, patient-centered, and coordinated care for Veterans with complex medical, behavioral health, and psychosocial needs as well as ensure that the Care Coordination and Integrated Case Management (CCICM) framework is implemented consistently, with oversight of policy adherence, training, and monitoring of care coordination standards. The position will also provide accessible, high-quality PACT social work services, addressing psychosocial barriers that impact health outcomes and reduce duplication of services, enhance communication among clinical programs, and improve care transitions throughout VHA's continuum of care. The position operates throughout the Veterans Health Administration (VHA) healthcare system, serving Veterans across outpatient and inpatient environments. Work may occur in PACT - providing direct clinical social work services as part of an interdisciplinary primary care team. Work may also occur within CCICM Program Infrastructure - collaborating with nursing counterparts, specialty care teams, navigators, case managers, and facility leadership. This position also works with the Care Coordination Review Team (CCRT) - co-leading interdisciplinary meetings focused on moderate- and high-complexity Veterans and will also utilize virtual modalities including Tele-Social Work and Tele-Mental Health, as required by national VHA standards. This role requires flexibility in working across multiple clinics and service lines, with duties occurring in offices, primary care settings, specialty clinics, and virtual platforms. CCICM Program Coordination - 50% -Leads implementation, coordination, and management of the CCICM framework, ensuring alignment with national guidance and accreditation standards through the following: - Collaborates with nursing leadership to develop, monitor, and evaluate CCICM operations - Identifies and monitors high-need Veteran cohorts requiring coordinated, integrated case management - Ensures integration with facility-wide care coordination teams, navigators, and specialty programs for seamless continuity of care - Provides oversight of CCICM education initiatives for staff and Veterans - Co-coordinates CCRT activities and assigns Lead Coordinators - Manages CCICM-related data tracking, reporting, and quality improvement activities PACT Social Work Services - 50% - Provides direct clinical social work services to PACT patients, including assessment, treatment planning, intervention, and follow-up - Participates in daily PACT huddles and interdisciplinary collaboration to support population health efforts - Provides crisis intervention, resource navigation, and solution-focused social work services - Ensures adherence to suicide prevention protocols, including Columbia-Suicide Severity Rating Scale (CSSRS), Comprehensive Suicide Risk Evaluation (CSRE), safety planning, and required documentation - Addresses psychosocial barriers impacting access, adherence, and overall health outcomes - Collaborates with medical, nursing, and behavioral health staff to support high-quality, Veteran-centered care This position functions at the GS-12 advanced practice level, requiring specialized experience, advanced licensure, and the ability to provide clinical supervision. The scope of work includes program coordination, administration, advanced clinical services, interprofessional leadership, and integrated case management. Work Schedule: Monday through Friday, 8 AM to 4:30 PM Recruitment/Relocation Incentives (Sign-on Bonus): May be authorized for highly qualified candidates 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) 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: ADHOC- May be available for highly qualified candidates Virtual: This is not a virtual position. Functional Statement #: 000000 Permanent Change of Station (PCS): Not Authorized
Requirements
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. 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 dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical examination. 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 1 or 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.
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/.
How you will be evaluated
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.