The incumbent assists Veterans in coping with acute illness, chronic illness, combating stress, community adjustment, addictions and other health and mental health problems. The incumbent addresses home care needs, homelessness and transition across levels and sites of care. Care includes psychosocial assessment, diagnosis and treatment, is focused on helping Veterans and their families maximize rehabilitation and treatment potential. Duties include but are not limited to: Uses the social work process (psychosocial assessment, diagnosis, and treatment) in collaboration with interdisciplinary team members to develop a care management plan and psychosocial interventions. Evaluates the need for mental health services and makes appropriate referrals where needed for individual, group, marital, and family treatment services. As a member of the health care team, participates fully in developing, planning, implementing and evaluating the interdisciplinary treatment plan, including provision of care management services. Coordinates care with the interdisciplinary team to promote continuity for Veterans and their families. In a crisis, performs rapid assessments and develops treatment management plans. In the event of a medical or psychiatric emergency, the social work case manager follows the policies and protocols of the Kansas City VAMC. Provides supportive counseling to help the Veteran and family cope with loss and grief experiences related to disability, terminal illness and death. Provides consultation/education to medical residents and staff members regarding social work case management practice, VA policies and procedures. Documents social work case management interventions and activities in the patient's clinical record utilizing CPRS, and assures appropriate hand-off communication when transferring patient care. Develops and uses appropriate community resources. Serves as an advocate for Veterans and their families, helping them access needed services at the facility, other VA facilities, and in the community. Assists Veterans and their families with advance directives, guardianships, and applications for health care, home care and extended care services. Participates in the orientation, training and teaching of social work graduate students and other trainees and staff. Conducts and/or participates in research and/or program evaluation as appropriate. Work Schedule: Monday - Friday, 730am to 4pm or 8am to 430pm Financial Disclosure Report: Not required
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