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 worker in this Veteran-Centric approach often functions as a care coordinator with a panel of Veterans to ensure that health care meets the needs, as defined by the Veteran. Within the PACT model, the social worker will complete assessments via phone, VVC or face to face. In addition the incumbent will provide case management to Veterans with high CAN scores or other complex needs. The Incumbent has knowledge of the PACT team approach and the role of each health and allied health care team members as well as an understandin
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