Social Worker - Patient Aligned Care Team (PACT)

Social Worker - Patient Aligned Care Team (PACT)

Department: Department of Veterans Affairs

Location(s): Portland, Maine, Togus, Maine

Salary Range: $64040 - $113777 Per Year

Job 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.

Major Duties:

• Total Rewards of a Allied Health Professional The Social Worker provides medical social work and case management services within the context of a patient-centered multidisciplinary team (Patient Aligned Care Team - PACT) to assist in the delivery of comprehensive care at the VA Maine Health Care System within Portland, ME CBOC. Duties may include, but are not limited to: Screening/Assessment Complete a psychosocial assessment to identify strengths, needs, social support systems, disabilities, and barriers to accessing needed services and available treatment options. Collaborates with the Veteran, available family members and significant others. Demonstrates an understanding of the range of issues and needs for Veterans of multiple eras and backgrounds, including physical limitations, psychological needs and age-associated mental health, substance abuse issues and physical conditions. Treatment Planning/Goal Setting Works with the Veteran to develop short term and long-term goals and plans, and referrals based on the Veteran's needs and preferences. Coordinates VA and community services and involves the VA primary care provider as needed. Proactively educates Veterans and families about long term care planning with a goal of avoiding unnecessary social hospitalizations Collaborates with the inpatient case manager in discharge planning for patients at high risk for re-admission due to psychosocial or environmental issues. Referral to service providers Is the subject matter expert on VA and/or community resources. Collaborates with other service providers in assessing the Veteran's needs. The social worker is responsible for educating the Veteran on the available services and assisting him/her in establishing the appropriate referrals based on preference and what is available in the community. Serves as a liaison with community professionals regarding coordination of services for veterans. Advocacy Understands the intimidation of bureaucracy and will act as an advocate when it serves the best interest of the Veteran. When it is appropriate and feasible, will educate and encourage the Veteran to advocate on his/her own behalf, thus fostering a sense of independence and empowerment. Education/Health promotion and prevention Provides education related to VA and community resources, entitlements, advance directives/living wills and will refer Veterans to the appropriate interdisciplinary team member for identified health education needs. Supportive counseling Provides the Veterans with ongoing supportive counseling. The purpose of such counseling is to deal with the psychosocial impact of coping with issues such as chronic medical conditions, financial stress, relationship stress, and adjustment to life changes. Administrative responsibilities Will enter all Veteran contacts in the electronic record using appropriate formats and templates. This information will be entered in a complete, confidential, professional, and timely manner to ensure information on the patient is shared with other VA staff. This information will be reviewed on a regular basis. Work Schedule: Full-time; Monday - Friday; 07:30am-4:00pm Compressed/Flexible: Not Authorized Recruitment Incentive (Sign-on Bonus): Not Authorized Permanent Change of Station (Relocation Assistance): Not Authorized EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact Hannah.Neilson@va.gov, the EDRP Coordinator for questions/assistance. Learn more EDRP Code:18 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: Not Authorized Virtual: This is not a virtual position. Functional Statement #: 000000 Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not Required

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: 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 the CSWE website 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 level. Current state requirements may be found on the OHRM website. Exception. VHA may waive the licensure or certification requirement for persons who are otherwise qualified, pending completion of state prerequisites for licensure/certification examinations. This exception only applies at the GS-9 grade level. For the GS-11 grade level and above, the candidate must be licensed or certified. At the time of appointment, the supervisor, chief social work, or social work executive will provide the unlicensed/uncertified social worker with the written requirements for licensure or certification, including the time by which the license or certification must be obtained and the consequences for not becoming licensed or certified by the deadline. English Language Proficiency: Candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. § 7403(f). **** See education for additional Information. 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 counseling skills when working with Veterans and family members. 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 Licensure 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. AND 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: 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-9 to GS-11. Physical Requirements and Work Environment: No special physical qualifications are required to perform the work. The work requires the ability to move around the office and facility. The work is performed in offices and meeting rooms.

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 12/18/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12825146. 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.

Application Deadline: 2025-12-18