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Summary The Care Coordination Integrated Case Management framework is a specialized, collaborative practice among multiple healthcare professions which provides structure and standards to support inter-professional collaboration throughout the continuum of care and optimal utilization of healthcare resources. CCICM serves a highly complex Veteran population, whose problems require a higher level of care coordination and case management. Responsibilities The Social Work Program Coordinator for Care Coordination Integrated Case Management or CCIM will implement standardized tools designed to integrate care to create a seamless continuum experience for the Veteran and will serve as a Lead Coordinator to this identified complex Veteran population. The aim of CCICM is to provide safe, efficient, and cost-effective interventions integrated throughout the continuum of healthcare; to improve access to care, reduce duplication and fragmentation of services, ensure adherence to professional standards of practice, and support staff in their work. Functions of Position Administrative responsibility for the clinical programming and daily operations of the VA Southern Oregon Rehabilitation Center and Clinics (VA SORCC) CCICM Practice. Ensures full collaboration with involved CCICM staff, for all planning, development, implementation, monitoring, and evaluation of the CCICM operations. Management, monitoring, evaluation and reporting on all CCICM related data to fully capture the day-to-day functioning and practice impacts on the facility and Veteran care. Plans, organized and directs CCICM operations, in conjunction with the CCICM counterpart(s), the Supervisory designed, and the Chief of SWS. Identification of Veteran cohorts across VA SORCC with the highest opportunity and highest need. Including development and implementation of a monitoring process for ongoing screening and identified cohort(s). Identification and tracking of potential areas where care coordination is taking place to include but not limited to primary care, mental health, community care, specialty clinics, geriatric extended care and homeless programs. Ensures integration with the facility level care coordination and case management teams to include but not limited to Nurse and Social Work navigators, care coordinators, care managers, and case managers for seamless continuity of care. Conducting psychosocial assessments to determine needs of Veterans and family members. Active participation in the treatment planning process with other disciplines, including involvement in discharge planning with other disciplines and will be responsible for ensuring that discharge plans are executed in a manner that are timely and appropriate. Provide case management to Veterans and families, as needed, throughout the continuum of care. Provide a full range of Social Work services within commonly accepted standards of social work practice which includes case work, individual, family and group counseling, discharge planning, case management and other services as appropriate. Work Schedule:Monday-Friday, 8:00am-4:30pm 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:May be considered by Supervisor after initial performance review. Virtual: This is not a virtual position. Permanent Change of Station (PCS):Not Authorized. Financial Disclosure Report: Not required Requirements Conditions of Employment Qualifications 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. English Language Proficiency Requirement - Per VA Handbook 5005, Part II, Chapter 3, Section A, Paragraph 3j: No person will be appointed under authority of 38 U.S.C., chapter 73 or 74, to serve in a direct patient-care capacity in VHA who is not proficient in written and spoken English. 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 http://www.cswe.org/Accreditation to verify that the social work degree meets the accreditation standards for a masters of 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 dependently practice social work at the master's degree level. Current state requirements may be found by going to http://vaww.va.gov/OHRM/T38Hybrid/. Grade Determinations: Social Worker GS-12 Program Coordinator Experience and Education: One year of experience equivalent to the GS-11 grade level. Experience must demonstrate possession of advanced practice skills and judgment, demonstrating progressively more professional competency. Candidate may have certification or other post-master's degree training from a nationally recognized professional organization or university that includes a defined curriculum/course of study and internship, or equivalent supervised professional experience. Licensure/Certification: Individuals assigned as social worker program coordinator must be licensed or certified at the advanced practice level, and must be able to provide supervision for licensure. Demonstrated Knowledge, Skills, and Abilities: In addition to the experience above, the candidate must demonstrate all of the following KSAs: Knowledge of program coordination and administration which includes consultation, negotiation, and monitoring. Knowledge and ability to write policies, procedures, and/or practice guidelines for the program. Ability to supervise multidisciplinary staff assigned to the program. Skill in organizing work, setting priorities, meeting multiple deadlines, and evaluating assigned program area(s). Ability to provide training, orientation, and guidance within clinical practice. Physical Requirements: Position requires performing activities including sitting, standing, walking, bending, carrying items such as books, papers, and files. References: VA Handbook 5005/120 Part II, Appendix G39. Education IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education. 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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. Additional Information Receiving Service Credit or Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employee's credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. Pandemic Telework Program: Due to COVID-19, the VA is currently in an expanded telework posture. If selected, you may be expected to temporarily telework, even if your home is located outside the local commuting area. Once employees are permitted to return to the office, you will be expected to report to the duty station listed on this announcement. [Management officials will provide information about returning to the official, pre-pandemic worksite, when applicable.] At that time, you may be eligible to request to continue to telework depending upon the terms of your organization's telework policy and the duties of the position. This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.