The Roudebush VA is seeking a Patient Aligned Care Team (PACT) Social Worker for the Primary Care team. The PACT Social Worker provides social work services to Veterans receiving primary health care in the PACT Clinics and specialty care in a specialty clinic at the Richard L. Roudebush VAMC
Duties included but are not limited to: Screening/Assessment- In conjunction with the interdisciplinary medical and psychiatric staff, the PACT Social Worker screens and assesses the Veteran's psychosocial needs and barriers in order to facilitate his or her access to appropriate VA and community resources. At times, the PACT Social Worker will screen or assess a Veteran who presents as a walk-in without association to a clinic visit.
Through collaborative relationships with the Veteran, his or her family/caregiver and other VA programs and VA staff, the PACT Social Worker coordinates the gathering of information vital to the process of setting appropriate treatment goals and time frames for achieving those goals.
Treatment Planning /Goal Setting- From screening/assessment information, the PACT Social Worker determines realistic goals with the Veteran, including such factors as a) the appropriate type of intervention and/or level of care, b) the setting conducive to providing such intervention or , c) the need for caregiver support to allow for the least restrictive level of , d) transportation options/barriers and e) the steps to obtaining resources (VA or community) that make the achievement of goals possible.
Referral to service providers- To facilitate the continuity of a Veteran's recovery, the PACT Social Worker will arrange referrals to needed VA and/or community resources (e.g., home health care, assisted living facilities, extended care facilities/nursing homes, services available through area agencies on aging, community support groups, hospice, community-based extended care).
The PACT Social Worker will collaborate with other service providers in re-assessing the Veteran's needs during the eligibility determination process, coordinating access to information needed for the referral. Additionally, the PACT Social Worker will educate the Veteran and/or caregiver about the available services and their shared responsibility in accessing such services.
The Veteran's preferences or that of his or her surrogate decision-maker will be considered throughout the referral and care coordination process. Resource Usage/Development- As a subject matter expert on the services and resources available to Veterans through both VA and the community, the PACT Social Worker will monitor patterns of resource availability, identifying unmet needs and the resultant impact on the Veteran's psychosocial functioning.
The PACT Social Worker will communicate with appropriate stakeholders (e.g., the Social Work Executive/Chief, the Social Work Professional Practice Council, other VA programs, community partners) to encourage the development of new and innovative resources. Advocacy- The PACT Social Worker will advocate for Veterans to ensure that they have access to all needed and resources within VA and in the community.
By availing the Veteran of his or her choices in complex decisions and by guiding the Veteran through complicated enrollment procedures and bureaucratic processes, the PACT Social Worker facilitates the best possible outcome for the Veteran. When appropriate and feasible, the PACT Social Worker will educate and encourage the Veteran and his or her family/caregiver to advocate on his/her own behalf, fostering independence and empowerment.
Crisis Intervention- The PACT Social Worker will assess and intervene in any medical or psychiatric crises presented by the Veteran and participate in developing crisis management and safety plans to minimize the event of future crises.
Work Schedule: Monday-Friday- 8:00 am- 4:30 pm Recruitment/Relocation Incentives (Sign-on Bonus): Not Authorized Permanent Change of Station (Relocation Assistance): Not Authorized Pay: Competitive salary and regular salary increases 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 Available Virtual: This is not a virtual position. Functional Statement #: A91770, A91771 Permanent Change of Station (PCS): Not Authorized
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/.
Caronica.Brown@va.gov · 9016930351
This position is with Veterans Health Administration, Department of Veterans Affairs.
The posted pay range is $62297 – $97991/yr.
Applications close on 2026-09-08.
This position is open under the 'Public' hiring path.
Source: USAJOBS.gov — U.S. Federal Government
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