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The Southern Arizona VA Health Care System (SAVAHCS) is currently recruiting for one (1) Social Worker, Home Based Primary Care (HBPC) to work at the Casa Grande CBOC, for the Rehabilitation & Transitional Care Line (RTCL). The incumbent provides a full range of social work services to veterans and families. Services include provision of high quality case management, clinical treatment, advocacy, and coordination of linkages to other appropriate VA or community service providers and/or agencies as needed by the client. Duties include but are not limited to the following:
- Develop an assessment of the veteran in collaboration with the interdisciplinary treatment team, the veteran, family members and significant others.
- Demonstrate an understanding of the range of treatment and skills needed for all adult patients including geriatric patients related to their physical limitations, psychological needs and age associated illnesses and conditions.
- Develop a treatment plan, and sets achievable treatment goals with the veteran/family based on the psychosocial assessment.
- Select and use treatment methods appropriate to the needs of each patient.
- Implement treatment plans through methods of casework, group work, and community organization or other modes of intervention consistent with his/her scope of clinical proficiency.
- Coordinate patient's discharge plans and arranges necessary placements in nursing homes, residential care homes or half-way houses.
- Engage other community services as needed and insures that adequate follow-up care has been provided as appropriate.
- Is the subject matter expert on VA and/or community resources.
- Responsible for educating veterans and/or caregivers of the available services and assisting them in establishing the referrals based on the veteran's preference or that of his surrogate decision-maker.
- Establish priorities for timely service delivery to prevent hardship for patient/families and prevent delays in discharge from treatment.
- Record social work activity in medical records.
- Provide assessments and/or develop crisis management plans for admission to mental health inpatient programs.
- Provide education related to VA and community resources, entitlements, Advance Directives/Living Will and will refer veterans/families to the appropriate interdisciplinary team member for identified health education needs.
- Assume responsibility for professional development.
Work Schedule: Monday-Friday 8:00am -4:30pm
Relocation Expenses: Relocation expenses are not authorized for this position.
Functional Statement Title/#: Social Worker (HBPC)
75% or less - Frequent travel to patient homes.