The Ralph H. Johnson VA Medical Center is a tertiary care teaching hospital providing the highest-level quality complex care from cardiology to neurology to primary and mental health care for approximately 80,000 Veterans along the South Carolina and Georgia coast. The 152-bed Level 1A hospital includes six community-based outpatient clinics, a 20-bed nursing home, women's health, and the full range of inpatient and outpatient care. For more information, visit www.charleston.va.gov. The Transition and Care Management (TCM) Program's Social Work Case Manager provides comprehensive social work service to Post 9/11 transitioning and established Servicemembers and Veterans (SM/Vs) and their families across the continuum of care and during the various phases of readjustment to civilian life. The incumbent independently provides an array of social work interventions including: high-risk screening, psychosocial assessments, treatment planning, resource education and referral, and case management. These services are provided in healthcare settings, both inpatient and ambulatory. In addition to the clinical and case management responsibilities, the incumbent assists with the public affairs component of the TCM Program's national mission through outreach. The primary responsibility of the position is to ensure the transition of care of Veterans and Active Duty Servicemembers, from the DoD Military Treatment Facilities (MTF) and Warrior Transition Units (WTU) to the Veterans Health Administration (VHA) is safe and continuous. The TCM SW Case Manager supports the Veteran, the Veteran's family, and the Veteran's Caregiver's and coordinates health needs across agencies, sites and unique episodes of care in order to optimize service delivery, improve quality of care, and enhance both patient experiences and outcomes. The TCM case manager performs clinical interventions and case management services, in collaboration with the other members of the TCM Program, and with guidance from the Interdisciplinary Care Management Review Team (IDCMRT) in order to meet the biological, psychological, and environmental needs of SM/Vs through a well-developed Inter-Agency Comprehensive Plan (ICP) Checklist. When determined by the IDCMRT, the TCM may serve as the Lead Coordinator for assigned patient. Work Schedule: Monday - Friday, 07:30am to 4:00pm 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.