Social Worker (Program Coordinator) HCHV

The Health Care for Homeless Veterans (HCHV) Outreach Social Work Coordinator located in the SFVA Health Care System (SFVAHCS) catchment area identifies and engages Veterans who are experiencing homelessness or marginally housed and who underutilize VA services.

The job functions for this position are listed below but not limited to as follows:

• Provide Veterans with a range of social work services including assessment and referrals clinical treatment short-term case management advocacy service coordination and linkage with VA and community resources. This is accomplished in concert with members of the CBOC interdisciplinary team and community providers. The incumbent also participates in outreach activities that are not directly related to homeless Veterans but to Veterans in general to provide information related to services and benefits available at SFVAHCS.
• Work confidently with city/county agencies to increase resources for on-the-street or marginally housed Veterans. The goal is to increase stability in Veterans lives and assist Veterans in returning to independent and healthy lifestyles. The incumbent will facilitate VA involvement in the CoCs Coordinated Entry System (CES) and will be responsible for assisting the SFVAHCS meet federal CES guidelines as described by regulations and guidance published by HUD.
• Coordinate efforts with local planning and support currently provided by VA HUD and USICH technical assistance initiatives designed to support local planning and the creation/sustainment of a CES. This involvement requires that the Coordinator is both aware and involved in current CoC plans to meet these federal requirements.
• Develop a bio/psycho/social assessment of the Veteran in collaboration with the Veteran the interdisciplinary treatment team available family members and significant others. The goal of the assessment is to highlight the Veterans strengths limitations and internal/external supports and service needs.
• Demonstrate an understanding of the range of treatment and needs of Veterans experiencing homelessness including OIF/OEF geriatric and gender-specific Veterans related to their physical limitations psychological needs and age-associated mental health substance use issues and physical conditions. The incumbent must understand stressors related to homelessness and the diversity of Veterans.
• Document the assessment with appropriate ROIs and will complete a HOMES assessment. As needed the incumbent re-assesses needs to meet the goals established in the initial intake plan. Time frames and requirements for assessments are completed as outlined by Joint Commission CARF and local medical center requirements/policies.
• Completes an initial assessment and Individualized Service Plan (ISP). The ISP includes Veteran strengths short & long-terms goals with measurable/S.M.A.R.T. objectives referral plans and specific history of (mental health substance abuse medical financial family sexual community/culture legal and housing).
• Provide case management services to Veterans as deemed appropriate to ensure follow- through and Veteran needs are being met. Case management services will vary depending upon Veteran needs and services are to be tailored to meet individual needs.
• Responsible for outreach to homeless Veterans and can work confidently with city/county agencies to increase resources for street homeless or marginally housed Veterans. The goal is to increase stability in Veterans lives and assist Veterans in returning to independent healthy productive lifestyles. The social worker will provide direct linkage from community services to SFVAHCS homeless program services through regular and consistent outreach and communication with community providers. This includes but is not limited to direct linkage to VA mental health services for those Veterans who are at high risk for suicide.
• Act as an advocate when it serves the best interest of the Veteran. When it is appropriate and feasible the incumbent will educate and encourage the Veteran to advocate on their behalf thus fostering a sense of independence and empowerment.
• Provides education related to VA and community resources entitlements advance directives/living wills and will refer Veterans to the appropriate interdisciplinary team member for identified health education needs.
• Provides the Veterans with ongoing supportive counseling. The purpose of such counseling is to assist the Veteran in coping with homelessness and understanding barriers to housing with a goal of being housed and gainfully employed when addition the social worker participates in leading various interdisciplinary treatment groups at the CBOC including but not limited to: Sobriety Support and Harm Reduction groups Advance Directive Education groups and other groups that promote general healthy welfare for the Veterans.

• 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.
• Must pass pre-employment physical evaluation
• As a condition of employment for accepting this position you might be required to serve a 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public 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.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements ( Effective May 7 2025 drivers licenses or state-issued dentification 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).

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 masters 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 masters degree in social work. Verification of the degree can be made by going to 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 masters degree level. Current state requirements may be found by going to Requirements. See VA Directive and Handbook 5019 Employee Occupational Health Services.
• English Language Proficiency. Candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. 7403(f).

• Experience and Education. One year of experience equivalent to the GS-11 grade level. Experience must demonstrate possession of advanced practice skills and judgment demonstrating progressively more professional competency. Candidate may have certification or other post-masters degree training from a nationally recognized professional organization or university that includes a defined curriculum/course of study and internship or equivalent supervised professional experience.
• Licensure/Certification. Individuals assigned as social worker program coordinator must be licensed or certified at the Advanced Practice Level and must be able to provide supervision for licensure.

• Knowledge of program coordination and administration which includes consultation negotiation and monitoring.
• Knowledge and ability to write policies procedures and/or practice guidelines for the program.
• Ability to supervise multidisciplinary staff assigned to the program.
• Skill in organizing work setting priorities meeting multiple deadlines and evaluating assigned program area(s).
• Ability to provide training orientation and guidance within clinical practice.