This position is located in the Mental Health Service under the direct clinical supervision of the Psychology Section Chief. Incumbent will function as a Care Coordinator for Veterans on a BHIP (Behavioral Health Interdisciplinary Program) team and will be responsible for coordination and continuity of care for Veterans receiving services throughout the Mental Health Service. 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. Licensure: Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree level. English Language Proficiency: Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree level. GS-11(Full Performance Level): Experience and Licensure. Appointment to the GS-11 grade level requires completion of 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. Education. In addition to meeting basic requirements, 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. Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, candidates must demonstrate all of the following KSAs: 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, cultural, ethnic, educational and other diversified 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. References: VA HANDBOOK 5005/120 PART II APPENDIX G39 The full performance level of this vacancy is GS-11 Physical Requirements: Traveling throughout the medical center is required, as is performing activities involving sitting, walking, standing, bending, and carrying such items as books, papers, and files. In carrying out responsibilities, it may be necessary for the incumbent to travel into the community where they conduct interviews with the Veterans, their families, representatives of community health and welfare agencies and law enforcement agencies. The incumbent must possess a current Driver's License and drive a government vehicle in carrying professional duties when deemed necessary. ["Duties to include, but not limited to: Responsible for providing care coordination services (including but not limited to biopsychosocial assessment, development of a comprehensive care plan, walk-in/crisis services, education, provision of self-management resources, referrals) and other clinical tasks as needed for Veterans receiving services in BHIP. Care coordination (including care management and/or case management) includes determining and monitoring care coordination needs over time, providing care coordination, and facilitating follow-up and outreach as needed to promote proactive, personalized care and care continuity. Coordinates care including serving as an advocate on behalf of the Veterans on BHIP teams to ensure delivery of comprehensive and seamless MH service and throughout Veterans' continuum of care. Responsible for following national guidance and local policy and SOPs for the Mental Health Service. This includes following pool and documentation requirements as required for CARF and The Joint Commission accreditation as well as other internal and external requirements. Must actively participates in program planning and development, advising the supervisor of shifting trends with care coordination needs and caseloads and identifying the need for making recommendations on program procedures and/or policy changes based upon work experiences. Must be able to take responsibility for improving professional skills, participating in planning, and executing specific staff development projects, attending seminars and institutes, and participating in training programs of other disciplines as requested. Must be able to recognize age-related needs and demonstrate knowledge and care appropriate to that age group. (Adult: less than 65 years of age, to the Geriatric: greater than 65 years of age) Responsible for protecting sensitive data from unauthorized release of access codes, etc. as stated in the computer access agreement, which you will sign. Provide a full range of services within commonly accepted standards of practice and prioritize care coordination activities as the primary job function [e.g., needs assessment, chart reviews, care/case management (as needed), discharge planning, outreach, etc. ] and other services as appropriate. Provides care coordination (including care management or case management) to Veterans and families, as needed, throughout the continuum of care, to include communication within and across care lines to facilitate continuity of care for Veterans. Conducts biopsychosocial assessments to determine care coordination and treatment needs of Veterans. Provides consultation/education to Veterans and families on VA resources (including self­ management tools), community resources, Advance Directives and VA benefits. Serves as an active participant in the treatment planning process with other disciplines. Participates in discharge planning with other disciplines and is responsible for ensuring that discharge plans are executed in a manner that is timely and appropriate to promote care continuity. Acts as a clinical resource/point-of-contact to Veterans and other team/staff members. Act as liaison between VA and community resources, to include education and bidirectional communication that promotes seamless care. Though not a core function of this position, there may be times when you may provide individual, family and group counseling as appropriate. Provides wellness/prevention education and may facilitate patient/family educational/bridging supportive sessions as appropriate. Documents interventions and activities in patient's electronic health record and ensure appropriate hand-off communication and documentation when transferring patient care. Maintains familiarity and shares responsibility with other team members for performance measures relevant to the BHIP team. Performs other BHIP-related duties as directed by the Supervisor, such as, but not limited to, training/mentoring and oversight of new staff & those not yet clinically licensed and preparing for and training staff on The Joint Commission standards and accreditation process. Participates in committee assignments, as deemed necessary by the service manager. Performs other duties as assigned. Work Schedule: Monday-Friday 7:30AM-4:00PM Telework: Ad Hoc; at discretion of Supervisor Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Financial Disclosure Report: Not required"]

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