Social Worker (GERI-PACT)

Work Schedule:
Dayshift; Monday - Friday Functional Statement Title:
Social Worker (GERI-PACT) The incumbent serves as the social worker for the GERI-PACT Team, a specialty clinic located within Primary Care.
The GERI-PACT is a comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus:
prevention; health promotion, coordination and chronic disease management.
The social worker in this Veteran-centric approach often functions as a care coordinator with a panel of veterans to ensure that health care meets the needs, as defined by the Veteran.
Social Workers are uniquely prepared for this role by virtue of their education, training, and experience which prepares them to understand the person-in-situation and the influences that family and community have in impacting the health-care needs of Veterans.
In conjunction with the GERI-PACT team, the incumbent assumes responsibility for the comprehensive, coordinated, primary care and specialized geriatric care of a panel of frail, chronically-ill patients of an advanced age.
The incumbent will collaboratively provide psychosocial services and longitudinal care coordination to these geriatric Veterans and families in an outpatient setting, Primary Care.
This social worker will complete psychosocial history and assessments, care planning, case management, family and individual counseling, psycho-education and coordination of services with VA and non-VA stakeholders.
This position serves as a member of an interdisciplinary treatment team, and as such must possess excellent interpersonal skills and be adept in the area of advocacy and negotiation within the context of an interconnected professional team of providers, veterans and other stakeholders.
The social worker will help the patient and family to understand the contributing factors to the problem(s), will discuss with them the pros and cons of possible short-term and long-term solutions, encouraging them to make positive and lasting changes to reduce stressors.
The social worker will coordinate with VA staff and community agencies to assist in problem solving as needed.

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