SUMMARY

This Primary Care Mental Health Integration (PCMHI) Social Worker position is administratively aligned with the Mental Health Service located at the Syracuse VA Medical Center. PCMHI is a component of the interdisciplinary Patient Aligned Care Team (PACT). The PCMHI SW is assigned both as a Colocated Collaborative Care (PCMHI CCC) behavioral health consultant, as well as a Collaborative Care Manager (PCMHI CoCM) in Primary Care. This is a combined PCMHI CCC and PCMHI CoCM position.

QUALIFICATIONS

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.

Basic Requirements:

• United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• Education. Have a master’s degree in social work from a school of social work fully accredited by the Council on Social Work Education (CSWE). Graduates of schools of social work that are in candidacy status do not meet this requirement until the School of Social Work is fully accredited. A doctoral degree in social work may not be substituted for the master’s degree in social work. Verification of the degree can be made by going to http://www.cswe.org/Accreditation to verify that the social work degree meets the accreditation standards for a masters of social work.
• Licensure. Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master’s degree level.
• English Language Proficiency. Candidates must be proficient in spoken and writtenEnglish to be appointed as authorized by 38 U.S.C. § 7403(f).

May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).

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/.

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.

IF YOU ARE RELYING ON YOUR EDUCATION TO MEET QUALIFICATION REQUIREMENTS:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

The PCMHI CCC social worker provides functional assessment, triage, brief intervention, education, and consultative services regarding a wide range of possible concerns. The PCMHI social worker maintains competences in the following core domains:

• PCMHI CCC Clinical Practice Management:
• Collaborates with PCPs and the interdisciplinary PACT to support high quality, effective, and coordinated service delivery at the patient and programmatic levels
• Utilizes intermittent visits and flexible patient contact strategies to support brief but longitudinal PCMHI care as part of PACT
• Performs other related clinical duties, as assigned, to meet patient needs
• Documentation Skills:
• Writes clear, concise notes that are optimized for collaboration within PACT based on the PCMHI CCC functional assessment and follow-up visit guidelines
• Consultation and Interdisciplinary Team-Based Skills:
• Engages in PACT huddles and meetings to cultivate collaborative team functioning and serve as a subject matter expert for behavioral health considerations
• Provides education to PACT on behavioral health and health behavior issues, as well as tips to promote effective patient communication, motivational enhancement, and behavior change
• Administration
• Serves on Medical Center or Healthcare System, VISN, and/or National VA committees or task forces, as endorsed by supervisors
• Participates in SW privileging, educational and peer review activities, in accord with SW and medical center policies
• Academic/Teaching/Training
• Supervises SW students in accord with training program policies and accrediting agency requirements
• Provides staff and student didactic training and consultation as requested in content areas of scholarly and/or clinical expertise
• Research/ Program Evaluation
• May participate in program evaluation and/or research activities, as endorsed/assigned by supervisor

DUTIES

The PCMHI CCC social worker provides brief, evidence-based interventions, education, and consultation services to Veterans, Primary Care Providers (PCPs), and allied PACT members. The PCMHI social worker works collaboratively within PACT to promote prevention, early identification, and treatment of most mild to moderate behavioral health and health behavior concerns as part of routine primary care. These services are provided in the outpatient Primary Care setting, in person and via telehealth, within a collaborative, interdisciplinary practice setting.
The PCMHI CoCM social worker provides evidence-based, condition specific (e.g., depression), protocol-driven services to collaboratively assist PACT providers in treating common mental health and health behavior concerns in primary care. PCMHI CoCM services include patient education, activation, behavioral interventions, monitoring of medication adherence and response, as well as other protocol-driven services. These services are provided in the outpatient Primary Care setting, in person and via telehealth, within a collaborative, interdisciplinary practice setting.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE DUTIES BELOW:

PCMHI CCC SW Clinical Practice:

The PCMHI CCC social worker provides functional assessment, triage, brief intervention, education, and consultative services regarding a wide range of possible concerns. The PCMHI social worker maintains competences in the following core domains:

• PCMHI CCC Clinical Practice Management:
• Collaborates with PCPs and the interdisciplinary PACT to support high quality, effective, and coordinated service delivery at the patient and programmatic levels
• Utilizes intermittent visits and flexible patient contact strategies to support brief but longitudinal PCMHI care as part of PACT
• Performs other related clinical duties, as assigned, to meet patient needs
• Documentation Skills:
• Writes clear, concise notes that are optimized for collaboration within PACT based on the PCMHI CCC functional assessment and follow-up visit guidelines
• Consultation and Interdisciplinary Team-Based Skills:
• Engages in PACT huddles and meetings to cultivate collaborative team functioning and serve as a subject matter expert for behavioral health considerations
• Provides education to PACT on behavioral health and health behavior issues, as well as tips to promote effective patient communication, motivational enhancement, and behavior change
• Administration
• Serves on Medical Center or Healthcare System, VISN, and/or National VA committees or task forces, as endorsed by supervisors
• Participates in SW privileging, educational and peer review activities, in accord with SW and medical center policies
• Academic/Teaching/Training
• Supervises SW students in accord with training program policies and accrediting agency requirements
• Provides staff and student didactic training and consultation as requested in content areas of scholarly and/or clinical expertise
• Research/ Program Evaluation
• May participate in program evaluation and/or research activities, as endorsed/assigned by supervisors

The PCMHI CoCM SW is an integral part of the PCMHI team. Duties include:

• Patient outreach and engagement in treatment
• Patient contact is frequently provided via telephone and written correspondence, however face-to-face care is within the scope of this position
• Initial assessment of the Veteran, including the following:
• Administration of validated patient reported outcome measure
• Review of assessments and documentation completed by others
• Obtain missing pertinent information from providers, patients, and medical records
• Routine use of a patient registry, including:
• Entry of all Veterans receiving PCMHI CoCM into a registry (e.g., Behavioral Health Lab software)
• Use of a registry to ensure patient follow-up, track engagement in PCMHI CoCM protocols, and monitor treatment response
• Participation in weekly caseload consultation with the consulting PCMHI Provider with Prescribing Privileges
• Actively seek out additional ad-hoc consultation as clinically indicated
• Continuously collaborate with the entire PCMHI team to ensure high quality, effective, Veteran-centered services at the patient and programmatic levels.
• Effectively communicate with patients, families, caregivers, VA leadership, and members of the interdisciplinary team
• Participate in PACT Huddles
• Participate in PCMHI Staff meetings
• Participate in VISN and National calls
• Other duties as assigned to support PCMHI and MH ICC operations

Work Schedule: Monday-Friday: 8:00am-4:30pm
Recruitment Incentive (Sign-on Bonus): Not authorized
Permanent Change of Station (Relocation Assistance): Not authorized
Telework: Not available
Virtual: This is not a virtual position.
Permanent Change of Station (PCS): Not authorized

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 (Schedule A)
• Disability Letter (VA)
• License
• Other (1)
• PCS Orders
• Professional Certification
• Resume
• Separation Notice (RIF)
• SF-15
• SF-50/ Notification of Personnel Action
• Transcrip

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 09/19/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12793554.

• 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