The Home Health Aide Program Social Worker position is located at the James J. Peters VA Medical Center in the Geriatrics & Extended Care (GEC) Service. They are responsible for coordinating home health aide care being provided to eligible Veterans, establishing, and maintaining community partner relationships, coordinating referral and processes with other internal VA offices or departments, and coordinating referrals/renewals and transitions of care between VA and community partners. The duties and responsibilities of the HHA Program Social Worker include both clinical and administrative elements for the home health aide programs. Coordinating the consistent provision of comprehensive home health aide services while ensuring compliance with established eligibility criteria and national guidance, ensuring equity of access, customer service, and benefits to this population is a primary function of this position. Specific duties, responsibilities, and required knowledge/skills include but are not limited to: PATIENT CARE COORDINATION / LIAISON: - Demonstrate ability to independently assess psychosocial functioning and clinical needs, formulating and implementing a plan of care in collaboration with the Veteran, family, and the interdisciplinary treatment team. - Assist as needed, with the clinical review and authorization process for home health aide referrals/renewals, in accordance with social work licensure and training. - Act as a point of contact and liaison for Veterans who are receiving care, to address concerns or issues related to their home health aide services. - Responsible to complete appropriate documentation, review, and follow-up on Veteran or agency complaints regarding home health services. - Utilize social work skills and abilities to work with patients/families experiencing a variety of medical, psychiatric, and social problems, utilizing psychosocial treatment modalities in an individual, family, or group setting. Possess advanced judgement and skill in utilizing supportive, problem solving, and/or crisis intervention techniques. - Monitor and coordinate authorizations for Veterans with ongoing care needs, utilizing a proactive approach to monitor reports in HSRM, the VSSC databases, etc., working collaboratively to alert ordering providers of expiring authorizations, and requesting new consults/orders for Veterans in need of continuing home health aide care. - Monitor incoming consults and referrals for care; responsible to follow approved process when unable to schedule care when program resources are not sufficient to meet identified needs. - Maintain up-to-date lists of approved agencies for home health aide services and other benefits/resources available to eligible Veterans. - Maintain awareness of current program information through participation in local, VISN, and national GEC meetings, conference calls, etc. COMMUNITY AGENCY COORDINATION & SUPPORT: - Conduct outreach to community-based agencies who provide care to Veterans on behalf of VA, or have an interest in doing so, encouraging partnerships with VA or community care networks to provide needed services. - Access and manage consult reports in VISTA to optimize workflow in coordinating consults, referrals, and addressing issues associated with home health aide services. - Assist community agencies in establishing work agreements with VA or other community care networks, working in conjunction with local OCC department to ensure process is completed. - Act as a primary point of contact and liaison for internal and external customers, addressing problems and challenges related to referrals, renewals, plan of care completion, documentation, billing processes, payment authorizations, etc. - Responsible to monitor approved agencies, addressing concerns when appropriate, to ensure compliance with established VA standards. Work Schedule: Monday -Friday 8:00am -4:30pm Telework: Not Available Virtual: This is not a virtual position. Position Title/Functional Statement #:Social Worker/PD24179F Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.