Social Worker - Patient Aligned Care Team

Summary

The Social Worker - Patient Aligned Care Team (PACT) serves as a Social Worker for the Community Based Outpatient Clinics (CBOCs). They work as part of an interdisciplinary team which delivers primary care to Veteran patients. Focus of work includes prevention, health promotion, coordination of care, referrals for additional services and crisis management.

Duties

• Total Rewards of a Allied Health Professional The Social Worker - PACT will collaboratively provide psychosocial services and longitudinal care coordination to primary care Veterans and families in an outpatient setting. Major Duties include, but are not limited to: Complete psychosocial history and assessments, care planning, case management, family and individual counseling, psychoeducation and coordination of services with VA and non-VA stakeholders. Serves as a member of an interdisciplinary treatment team. May serve on committees, councils, workgroups, and/or task forces. Serves as liaison to community agencies and networks with agency representatives. 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 and/or their families. 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. Case management with members of the outpatient interdisciplinary team is provided in order to 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 Services include but are not limited to homelessness, hospice services, nursing home care, home health services, financial resources, VA benefits, and transportation services. All other duties as assigned, pertaining to this occupation, to meet the needs of the Agency, Department, Facility, and/or Service. Work Schedule: Full-Time, Monday-Friday 8:00am-4:30pm Recruitment/Relocation Incentives (Sign-on Bonus): Not authorized. Permanent Change of Station (Relocation Assistance): Not authorized. Pay: Competitive salary and regular salary increases. When setting pay, a higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA (Above Minimum Rate of the Grade). 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) Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience. 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: Ad-hoc telework may be approved as determined by Agency policy. Virtual: This is not a virtual position. Functional Statement #: 24068-F, 24069-F Permanent Change of Station (PCS): Not authorized.

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. English Language Proficiency - You must be proficient in spoken and written English as required by 38 U.S.C. 7403(f) Education and/or Experience Combination - You must possess 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. Note: A doctoral degree in Social Work may NOT be substituted for the master's degree in Social Work. License or Certification* - You must be licensed or certified by a state to independently practice social work at the master's degree level. *Exception - For assignments at the GS-9 level, VHA may waive the licensure or certification requirement for persons who are otherwise qualified, pending completion of state prerequisites for licensure/certification examinations. VHA social workers who are not licensed or certified at the time of appointment must become licensed or certified at the independent, master's level within three years of their appointment as a social worker. 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: GS-09 Social Worker -Knowledge, Skills and Abilities: In addition to meeting the basic requirements, to qualify for the GS-09, you must demonstrate the following Knowledge, Skills and Abilities: Ability to utilize a Veteran centric approach when providing interventions and counseling for Veterans, their family members, caregivers, and survivors. Ability to assess the psychosocial functioning and needs of Veterans and their family members, and to formulate and implement a treatment plan, identifying the Veterans problems, strengths, weaknesses, coping skills, and assistance needed. Ability to implement treatment modalities in working with individuals, families, and groups to achieve treatment goals. This requires judgment and skill in utilizing supportive, problem solving, or crisis intervention techniques. Ability to establish and maintain effective working relationships and communicate with clients, staff, and representatives of community agencies. Fundamental knowledge of medical and mental health diagnoses, disabilities, and treatment procedures. This includes acute, chronic, and traumatic illnesses/injuries; common medications and their effects/side effects; and medical terminology. GS-11 Social Worker: License Requirement - You must be licensed or certified by a state to independently practice social work at the master's degree level. Experience or Education Requirement: In addition to meeting the basic requirements, to qualify for the GS-11, you must possess a minimum of one year of post-MSW experience equivalent to the GS-9 grade level in the field of health care or other social work-related settings, (VA or non- VA experience) and licensure or certification in a state at the independent practice level. Examples of specialized experience include but are not limited to: Working under close supervision in program areas that do not require specialized knowledge or experience. Identifying behaviors or symptoms of abuse, neglect or exploitation; providing education on advance directives and advanced care planning; providing social work case management; acting as an patient/family member/caregiver advocate with community service providers/agencies; assessing the psychosocial functioning and needs of patients and their family members. In collaboration with the patient, family, and interdisciplinary treatment teams, identifying strengths, weaknesses, coping skills and psychosocial acuity. Maintaining a current network of internal and external resources to educate the patient and/or family members/caregivers and assist with appropriate referrals. -OR- a doctoral degree in social work from a school of social work may be substituted for the required one year of professional social work experience in a clinical setting. In addition to the experience above, you must demonstrate the following Knowledge, Skills and Abilities: Knowledge of community resources, how to make appropriate referrals to community and other governmental agencies for services, and ability to coordinate services. Skill in independently conducting psychosocial assessments and treatment interventions to a wide variety of individuals from various socio-economic, educational, and other backgrounds. Knowledge of medical and mental health diagnoses, disabilities and treatment procedures (i.e. acute, chronic and traumatic illnesses/injuries, common medications and their effects/side effects, and medical terminology) to formulate a treatment plan. Skill in independently implementing different treatment modalities in working with individuals, families, and groups who are experiencing a variety of psychiatric, medical, and social problems to achieve treatment goals. Ability to provide consultation services to new social workers, social work graduate students, and other staff about the psychosocial needs of patients and the impact of psychosocial problems on health care and compliance with treatment. Preferred Experience: One year of medical social work experience, preferably in an ambulatory setting. 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-11. The actual grade at which an applicant may be selected for this vacancy is in the range of GS-09 to GS-11. Physical Requirements: Physical aspects associated with work required of this assignment are typical for the occupation, see Duties section for essential job duties of the position. May require standing, lifting, carrying, sitting, stooping, bending, pulling, and pushing. May be required to wear personal protective equipment and undergo annual TB screening or testing as conditions of employment.

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 identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical evaluation. 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 09/18/2026 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/13060457. 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.