Social Worker (Program Coordinator CCICM)

Summary

This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application.

Duties

• Major Duties: 75% CCICM Coordinator Duties. 25% PACT Duties Incumbent serves as the Care Coordination and Intensive Case Management (CC & ICM) Coordinator and Patient Aligned Care Team (PACT) Clinical Social Worker. The incumbent must use a high level of skill in assessing and treating the complicated psychosocial problems of Veterans. Social Work responsibilities include the assessment of psychosocial problems, often at a time when the Veteran is experiencing crisis and include the provision of short-term, solution-focused counseling with Veterans, their family members, and/or caregivers. Referrals typically originate from members of the interdisciplinary team, from Veterans and/or their family members/significant others coming as walk-ins to seek assistance, and from community professionals. The incumbent must 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. Has primary knowledge of use of medical and mental health diagnoses, disabilities, and treatment procedures. This includes acute, chronic, and traumatic illness, injuries, medical terminology, and common medications and their effects and side effects. Independently identifies high-risk patients and provides case management services for chronic disease management in collaboration with the multidisciplinary team. Complex cases are staffed regularly with the clinical supervisor. Utilizes the Patient Aligned Care Team (PACT) template assessments to synthesize information into a working document that provides direction in determining the level of care, level of case management and follow up. Differentiates between episodic, supportive, progressive, and intensive case management. Independently provides crisis intervention services if needed, seeking to address cause, as well as the presenting complaint, coordinates family conferences, and serves as liaison to family members. Formulates a plan with goals, objectives, barriers, and needs based on PACT templates for ongoing follow up and case management. Independently conducts psychosocial assessments as appropriate for treatment planning. Assessment is to highlight the Veteran's strengths, limitations, internal and external supports, and service needs in order to optimize functional status. Identifies the psychosocial complications that can be caused due to a sudden onset of an acute or chronic illness. Provides treatment interventions in collaboration with the Veteran and family, interdisciplinary treatment team, and community members. The incumbent possesses knowledge and ability to implement treatment modalities including motivational interviewing (MI) to provide supportive counseling and health coaching to individuals, families, and groups. Incumbent has an understanding of the range of treatment and skills for all adult patients related to illness or chronic medical conditions, psychological needs, and age-associated conditions. Incumbent possesses the skills to establish therapeutic relationships with Veterans and families, mediate difficulties, and measure outcomes of treatment interventions. Provides pro-active case management to assist in eliminating barriers to health care interventions based on the level of case management indicated in the initial and follow up assessments. Offers strategies to resolve underlying causal factors and build upon and promote strengths and abilities. Coordinates community-based services, including information and referral for additional services from other VA programs, other government programs, and community agency programs. Provides education to community care partners regarding general VA benefits and services in the course of care coordination for Veterans. Follows Veteran/Caregiver through continuum of health care. Has general knowledge of Veterans' benefits and services relating to special programs, service-connected compensation, and non-service-connected pension. Facilitates referrals and applications for benefits based upon Veterans' needs and eligibility. Provides education to Veterans and families related to VA benefits and services, community resources, entitlements, and completion of Advanced Directives and Living Wills. Refers Veteran and families to the appropriate interdisciplinary team member for identified health needs. Work Schedule: 8:00am -4:30pm Monday - Friday EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact [email protected], the EDRP Coordinator for questions/assistance. Learn more Telework: Adhoc only Virtual: This is NOT a virtual position. Functional Statement #: 00000000

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. 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: Master's degree in social work (MSW) 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 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 master's degree in social work. Verification of the degree can be made by going to the CSWE website (www.cswe.org) to verify if that social work degree meets the accreditation standards for a Master of Social Work. Licensure: Persons hired or reassigned to social worker positions in the GS-185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree levels. English Language Proficiency: Candidates must be proficient in spoken and written English as required by 38 U.S.C. 7403(f). May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Grade Determinations: Social Worker (Program Coordinator), GS-12 Experience and Education: One year of experience equivalent to the GS-11 grade level. Experience must demonstrate possession of advanced practice skills and judgment, demonstrating progressively more professional competency. Candidate may have certification or other post-master's degree training from a nationally recognized professional organization or university that includes a defined curriculum/course of study and internship, or equivalent supervised professional experience. (2) Licensure/Certification: Individuals assigned as social worker program coordinator must be licensed or certified at the advanced practice level, and must be able to provide supervision for licensure. (3) Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs: (a) Knowledge of program coordination and administration which includes consultation, negotiation, and monitoring. (b) Knowledge and ability to write policies, procedures, and/or practice guidelines for the program. (c) Ability to supervise multidisciplinary staff assigned to the program. (d) Skill in organizing work, setting priorities, meeting multiple deadlines, and evaluating assigned program area(s). (e) Ability to provide training, orientation, and guidance within clinical practice. Assignments: For all assignments above the full performance level, the higher-level duties must consist of significant scope, complexity (difficulty), and variety and be performed by the incumbent at least 25% of the time. Program coordinators at the GS-12 grade level are administratively responsible for a clinical program providing treatment to Veterans in a major specialty area, such as but not limited to: Spinal Cord Injury, Homeless Continuum Veteran Program, Hospice and Palliative Care Program, Suicide Prevention Program, Veterans Justice Outreach, Caregiver Support Program and Community Nursing Home Program. The program coordinator may be the sole practitioner in this specialty at the facility and typically provide direct patient care services in the program area. The program coordinator oversees the daily operation of the program, develop policies and procedures for program operation, and prepare reports and statistics for facility, VISN, and national use. They may be responsible for the program's budget, developing and monitoring staff compliance with practice, standards and guidelines on documentation, workload, data entry, ethical practice and service delivery. The program coordinator provides analysis and evaluation of clinical program data and computerized programs to identify system-wide trends and needs to enhance the quality of service. They may be responsible for, or contribute to, the program's resource and fiscal management, monitoring control points developing the annual budget, operating within that budget, and accounting for appropriated funds. The program coordinator is administratively responsible for the clinical programming and prepares reports and statistics for facility, VISN, and national use. They provide leadership, direction, orientation, coaching, in-service training, staff development, and continuing education programs for assigned staff. They initiate and conduct a variety of program or service audits and complete designated clinical practice audits and reports, including productivity assessments. They oversee program operations and evaluations, identifying areas for improvement, gathering relevant data, assessing the data, developing and implementing ideas for improvement and evaluating efficacy of improvement efforts.] 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. Physical Requirements: Light Lifting (15 lbs. and under); Light Carrying (15 lbs. and under); Both hands required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16"; Far vision correctable in one eye to 20/20 and to 20/40 in the other; Hearing (aid permitted); emotional and mental stability.

Requirements

You must be a U.S. Citizen to apply for this job. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. 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. 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 to apply

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 09/09/2026 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/13051629. To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire. Click Submit My Answers to submit your application package. NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.