The Patient Aligned Care Team (PACT) is a comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus: prevention; health promotion, coordination and chronic disease management. The Social Work in this position is assigned to York VA Community Clinics, PACT, and Specialty Clinics. The Social Worker in this Veteran-centric approach often functions as a care coordinator with a panel of veterans to ensure that healthcare meets the needs, as defined by the Veteran. The incumbent is responsible for assessment, planning, and provision of case management services in the PACT and Specialty clinics. Coordinates a variety of activities including outreach, interdisciplinary activities, psychosocial assessments, treatmen
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