Social Worker- Community Nursing Home

Summary

The Community Nursing Home (CNH) Social Worker provides oversight, care coordination, and discharge/disposition planning for Community Nursing Home Veterans. Reviews and assists referrals to CNH facilities and performs follow-up and oversight visits after admission to the CNH to ensure adequate and safe care is being provided. Advocates for holistic care through education and provider interaction and implements an educational plan to meet the patient care needs.

Duties

Total Rewards of a Allied Health Professional Duties and skills needed to be successful in this position include, but are not limited to: The incumbent independently coordinates high-risk patients and provides care management services to Veterans and families. The incumbent participates in the admission screening process and assists in coordinating the admission. The incumbent establishes and maintains effective therapeutic relationships with patients and their families. The incumbent independently works with patients and families who are experiencing a variety of psychiatric, medical, and social problems utilizing individual, group and family counseling and therapy skills. The incumbent conducts psychosocial assessments to determine the needs of Veterans and family members. The incumbent possesses the skills to offer psychosocial interventions and measure outcome to interventions. The incumbent coordinates community-based services, including information and referral for additional services from other VA government, and community agency programs. The incumbent assists with discharge planning from the Community Nursing Home and coordinates with the nursing home, PACT and/or specialty programs to ensure continuity of care. The incumbent independently provides consultation services to other staff regarding the psychosocial needs of Veterans and the impact of psychosocial problem on health care and adherence to treatment plans. The incumbent evaluates their own practice through professional peer review, case conference and other organization means. The incumbent communicates effectively both orally and in writing with people from varied backgrounds. The incumbent develops an assessment of the Veteran in collaboration with interdisciplinary treatment teams, the Veteran, family members and significant others, whenever possible. The incumbent meets the needs of customers while supporting VA missions. The incumbent handles conflict and problems in dealing with consumer constructively and appropriately. The incumbent utilizes word processing, data management, email, CPRS and other computer systems, especially those programs in use by VHA. The incumbent documents all efforts in the electronic medical record in a professional and timely fashion. The incumbent will participate in committee assignments as deemed necessary by the service manager. The incumbent is responsible for assuring that monthly follow-up visits to Veterans in the CNHs are completed and documented utilizing CPRS and ensure appropriate hand off when transferring of patient care, as required by the program. The incumbent is responsible for providing input to the CNH Coordinator and/or Supervisor to assist in assuring that Quality Assurance monitors related to these programs are completed and reported to the CNH Oversight committee. The incumbent is involved in the annual inspection of the nursing homes with lead support provided by the CNH Coordinator and/or Supervisor. Incumbent must possess and maintain a current, valid, and unrestricted state drivers license in order to operate a government owned vehicle. The incumbent performs other duties as assigned. Work Schedule: Monday-Friday, 7:30am-4:00pm Recruitment Incentive (Sign-on Bonus): Not Authorized Permanent Change of Station (Relocation Assistance): Not Authorized Pay: Competitive salary and regular salary increases when setting pay, a higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA (Above Minimum Rate of the Grade). 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: Ad-Hoc Virtual: This is not a virtual position. Functional Statement #: 56782-A,56783-A Permanent Change of Station (PCS): Not Authorized

Requirements

You must be a U.S. Citizen to apply for this job. Selective Service Registration is required for males born after 12/31/1959. Must be proficient in written and spoken English. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Complete all application requirements detailed in the "Required Documents" section of this announcement. As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

Qualifications and evaluation

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, resume, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position. It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment. Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.

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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

How to apply

All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 09/25/2026 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/13064380. To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire. Click Submit My Answers to submit your application package. NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

Required documents

To apply for this position, you must provide a complete Application Package which includes: Long-form resume/Curriculum vitae (CV) Transcript The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), etc. Cover Letter DD-214/ Statement of Service Disability Letter (VA) License Long-form resume/Curriculum vitae (CV) Other (1) SF-15 SF-50/ Notification of Personnel Action Transcript Veterans' Preference: When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference. Veterans' preference does not apply for internal or other current permanent Federal agency employees.

Additional information

Receiving Service Credit for 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. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. 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. During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions. 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 an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.