This position is located within VA Altoona and it's affiliated CBOC's. The Senior Social Worker performs duties within a dual capacity in the Community Nursing Home (CNH) and Home Based Primary Care (HBPC). Incumbent is responsible for providing administrative oversight and providing clinical case management throughout the catchment areas.
Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. Education: Have a master's degree in social work from a school of social work fully accredited by the Council on Social Work Education (CSWE). Graduates of schools of social work that are in candidacy status do not meet this requirement until the School of Social Work is fully accredited. A doctoral degree in social work may not be substituted for the master's degree in social work. Verification of the degree can be made by going to http://www.cswe.org/Accreditation to verify that the social work degree meets the accreditation standards for a masters of social work. Licensure: Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree level. Current state requirements may be found by going to http://vaww.va.gov/OHRM/T38Hybrid/. Grade Determinations: Senior Social Worker, GS-12 Experience/Education: The candidate must have at least two years of experience post advanced practice clinical licensure and should be in a specialized area of social work practice of which, one year must be equivalent to the GS-11 grade level. Senior social workers have experience that demonstrates possession of advanced practice skills and judgment. Senior social workers are experts in their specialized area of practice. Senior social workers may have certification or other post-masters training from a nationally recognized professional organization or university that includes a defined curriculum/course of study and internship or equivalent supervised professional experience in a specialty. Licensure/Certification: Senior social workers must be licensed or certified by a state at the advanced practice level which included an advanced generalist or clinical examination, unless they are grandfathered by the state in which they are licensed to practice at the advanced practice level (except for licenses issued in California, which administers its own clinical examination for advanced practice) and they must be able to provide supervision for licensure. Demonstrated Knowledge, Skills, and Abilities: In addition to the experience above, candidates must demonstrate all of the following KSAs: Skill in a range of specialized interventions and treatment modalities used in specialty treatment programs or with special patient populations. This includes individual, group, and/or family counseling or psychotherapy and advanced level psychosocial and/or case management. Ability to incorporate complex multiple causation in differential diagnosis and treatment within approved clinical privileges or scope of practice. Knowledge in developing and implementing methods for measuring effectiveness of social work practice and services in the specialty area, utilizing outcome evaluations to improve treatment services and to design system changes. Ability to provide specialized consultation to colleagues and students on the psychosocial treatment of patients in the service delivery area, as well as role modeling effective social work practice skills. Ability to expand clinical knowledge in the social work profession, and to write policies, procedures, and/or practice guidelines pertaining to the service delivery area. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The full performance level of this vacancy is GS-12. The actual grade at which an applicant may be selected for this vacancy is GS-12. Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Services.
The CNH Coordinator will work collaboratively with CNH staff, JEVZ staff, and nursing home staff; be knowledgeable of VA and community resources; provide information/education to nursing home staff, JEVZ staff, Veterans and caregivers; and serve as a liaison between the nursing home and primary care team to assist with coordination of care needs. The CNH Coordinator will also be responsible for Contracting Officer's Representative (COR) duties, acting as a liaison and maintaining COR level 2 certification. The CNH Coordinator will conduct initial and annual CNH facility assessments, completing required forms and ensuring storage of forms locally and nationally; attend monthly meetings with VISN REC-ICC Lead; ensure all CNH documentation is accessible and following national standards. The CNH Coordinator will lead the CNH Review Team and act as facilitator for the CNH Oversight Committee; be responsible for writing Issue Briefs and Heads Up Notifications; and track and report program data and outcomes. The CNH Coordinator may complete on-site visits to the nursing homes for clinical assessment; participate in interdisciplinary care plan meetings facilitated by the nursing homes; facilitate referrals and consults and ensure that the Veteran's identifying concern is addressed and concluded by the receiving consultant; and complete discharge planning with nursing home staff. The HBPC Social Worker will complete comprehensive initial clinical assessments; complete follow-up assessments at a minimum annually and when clinically indicated; identify psychosocial issues impacting the Veteran/caregiver ability to achieve optimal outcomes; implement interventions; and provide case management. The HBPC Social Worker will develop a psychosocial plan of care which may include individual/family counseling, grief and bereavement counseling, advance care planning, pain interventions, stress management, caregiver respite, and psycho-education; facilitate access to and maximize VA and community resources and services; interact, coordinate and advocate for the Veteran/caregiver; provide education to the Veteran/caregiver; assess and support the caregiver's capability to continue to provide care; complete screenings/reminders; and assist with discharge planning. The HBPC Social Worker will keep the HBPC team informed of available resources and supports; participate in the development of the individual plan of care; participate in the development and implementation of the HBPC's process for continuous improvement; participate in interdisciplinary care meetings; document patient care accurately and timely; participate in the determination or the appropriateness of Veterans admission to or discharge from HBPC; and participate in the development of a local SOP's and have knowledge of The Joint Commission (TJC) to include TJC Accreditation Manual for Home Care. Performs other duties as required. Work Schedule: 8:00am - 4:30pm, Monday - Friday Telework: Not available Virtual: This is not a virtual position. Functional Statement #: 000000 / Senior Social Worker Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized