Social Worker-HCHV Outreach Case Manager-Rural

Job Title

Rural Outreach Social Worker

Duties

The duties include but are not limited to:

• Ability to provide psychosocial treatment to a wide variety of individuals from various socioeconomic, cultural, ethnic, educational, and other diversified backgrounds.
• Ability to provide consultation services to other staff about the psychosocial needs of patients and the impact of psychosocial problems on health care and compliance with treatment.
• Ability to independently evaluate his/her own practice through participation in professional peer review case conferences, research studies, or other organized means.
• Develops and maintains a network of relationships with community resources and other advocates for the homeless to effectively screen and identify Veteran members of the homeless population. Depending upon need, the Rural Outreach Social Worker makes VA or community­ based referrals, advocates for scarce resources, confirms referrals are completed and provides intensive follow-up and coordination with these agencies.
• Interviews potential clients interprets VHA guidelines and eligibility requirements and completes a psychosocial history and assessment.
• Initiates eligibility determination, and forwards to VA eligibility staff members. Establishes an initial assessment at the time of the first visit.
• May be required to develop an appropriate treatment plan. Using known available resources and the initial assessment makes initial and continuing decisions regarding the services available, and referrals needed. Decisions are based upon the employee's professional judgment with regards to the individual's rehabilitative potential and possible consequences of less controlled rehabilitative efforts.
• Incumbent will participate in Care coordination meetings, By Name List Meetings, and HCHV Outreach National Calls to remain updated on latest initiatives and relevant items related to the program.
• Documents the patient assessment and all treatment plans in accordance with the requirements of Medical Center policy and requirements of various accrediting bodies.
• Provides clinical services to clients. Provides guidance, emotional support and other assistance. Involves clients in individual or group counseling. Makes provision for referral services to other agency organizations, community resources, or other Governmental resources to resolve problems. Highly developed professional skills are routinely used to motivate dysfunctional clients to resume more effective control of their own life.
• Employs casework methods and techniques to maintain a therapeutic relationship that will help the client work towards the best way of dealing with his/her problems.
• Arranging for provision of care through VA or community resources in cases in which the Veteran is at risk and eligibility is not yet determined by VA medical facility Enrollment and Eligibility Staff or the Veteran is only eligible for limited services based on discharge status that is other than honorable.
• Communicating with all team members (including Veterans and caregivers) to convey clinically relevant information for the care of the Veteran.
• Other duties as assigned.