The RN Care Coordinator provides care coordination for veterans who are assigned to a Geriatric Patient Aligned Care Team (PACT). Coordination of care and services for veterans that includes but is not limited to veterans with chronic disease, veterans with limited functional status, complex medical, psycho-social and/or mental health needs, severely-injured service members and veterans, and veterans with intensive continuing care needs that will require coordination of and referrals to various levels of care. The incumbent begins the coordination process at the time the patient is identified and works collaboratively with staff within the Patient Aligned Care Team as well as staff throughout the Veterans Health Administration (VHA) facility that may also be involved in his/her care, staff from other VHA facilities, Military Treatment Facilities, and referring facilities/community agencies. The RN Care Coordinator completes an assessment of functional status, acuity level, prognosis, and assesses the need for treatment services and resources. The RN Care Coordinator initiates contact with the veteran and/or caregiver to assist and ensure best clinical outcomes, quality of life, and a seamless transition between facilities and levels of care. The RN Care Coordinator monitors veteran's status and health services use while the veteran is receiving care from the PACT. The incumbent communicates and collaborates with the Interdisciplinary Team to develop and coordinate the treatment plan for veterans in the inpatient or outpatient setting.. The incumbent, in collaboration with the Interdisciplinary Team, is responsible for coordinating performance improvement initiatives and for collecting relevant data required for Commission on Accreditation of Rehabilitation Facilities (CARF) certification and Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards. The RN Care Coordinator provides appropriate care for the veterans, taking into consideration diagnosis and physical, psychosocial, spiritual, cultural, environmental and social support needs.
VA offers a comprehensive total rewards package: VA Nurse Total Rewards
Pay: Competitive salary, regular salary increases, potential for performance awards
Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)
Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA
Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)
Licensure: 1 full and unrestricted license from any US State or territory
Work Schedule: Monday-Friday,0800-1630
Telework: Available Ad Hoc only
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
Starting at $83,345 Per Year (VN 00)