The Patient Aligned Care Team is a comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus: prevention; health promotion, coordination, and chronic disease management. The social worker in this Veteran-Centric approach often functions as a care coordinator with a panel of Veterans to ensure that health care meets the needs, as defined by the Veteran. The Social Worker is a professional social worker assigned to the Primary Care Patient Aligned Care Team. Must use a high level of skill in assessing and treating the complicated psychosocial problems of Veterans and their families/significant others. Social work responsibilities include the assessment of psychosocial problems that cause distress, often impacting the health condition and creating barriers to care. These stressors can include adjustment to the current medical condition, untreated or under-treated mental health or substance abuse condition, economic instability, legal problems, and inadequate housing and transportation. Referrals typically originate from any member of the interdisciplinary team, from Veterans and/or their families who call or walk-in for assistance, and from community professionals. Must complete thorough assessments to determine the underlying causes of the presenting problem(s), the interpersonal and environmental factors impacting the problem, and its effect on the patient's ability and desire to comply with the treatment recommendations by the multidisciplinary team. Help the patient and family to understand the contributing factors to the problem(s), will discuss with them the pros and cons of possible short-term and long-term solutions, encouraging them to make positive and lasting changes to reduce stressors. Coordinate with VA staff and community agencies to assist in problem solving as needed. 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 for Veterans and/or their families. Work Schedule: Monday - Friday; 8:00 AM - 4:30 PM Financial Disclosure Report: Not required Relocation/Recruitment Incentives: Not Authorized Relocation Expenses: Not Authorized
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.