Nurse (Remote Patient Monitoring - Home Telehealth Program) – Amazon Store
Summary The RN Care Coordinator provides care and counseling of persons based upon the nursing process which includes systematic data gathering, assessment, appropriate nursing judgment, and evaluation of human responses to health problems through such services as case finding, health teaching, health counseling, provision of care supportive to well-being, and executing medical regimens including administering medications and/ or treatments prescribed by a licensed or legally authorized provider. Duties Help The RN Care Coordinator duties consist of but are not limited to:
- Directs care for a panel of patients throughout the continuum of care to ensure that care is timely, appropriate, high quality, and cost-effective.
- Works closely with program staff, the primary care provider (or providers), Patient Aligned Care Team (PACT) members and other healthcare professionals throughout the health care system, internal or external services and community agencies, and medical center leadership.
- Provides professional assessment, coordination, and planning of multiple health care services acts on behalf of the Veteran to assure that necessary clinical services are received, and that progress is being made.
- Provides ongoing evaluation of care management services provided to Veterans.
- Providing initial and ongoing comprehensive assessment, including a review of systems that establish a comprehensive plan of care. The Care Coordinator identifies, analyzes, and prioritizes problems and interventions and sets appropriate measurable goals (i.e., Specific, Measurable, Attainable, Realistic, and Timely [SMART] goals). The treatment plan is an extension of the Veteran's primary care plan and is completed in collaboration with PACT, HBPC, mental health care, and other specialty care services, as appropriate for each Veteran enrolled in the program.
- Triaging and assessing all data received from RPM-HT Program patients, such as vital signs, reported symptoms, and question responses.
- The Care Coordinator will review daily responses each workday and contact Veterans about worrisome responses and trends, significant changes in condition, or changes in other specific data elements received, as clinically appropriate. Ideally, Care Coordinators should contact Veterans when responses indicate that an issue may be developing in order to provide education, offer self-management tips, and assist with problem-solving, rather than waiting until a red alert shows that the situation may be out of control.
- The incumbent completes an assessment of patients who may have multiple and complex comorbidities that necessitate additional coordination of care and case management to ensure easily accessible, continuous, high-quality care across all settings.
- The incumbent provides ongoing professional assessment and case management to an adult population of predominantly (but not limited to) older male patients.
- Completes assessment and plan of care on assigned patients and provides individualized nursing care.
- Conduct ongoing reassessments to evaluate changes in patients' status.
- Identifying and intervening to address potential exacerbations or complications in order to facilitate timely care in a clinic, emergency response urgent care setting, or care in the community.
- U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
- All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
- Selective Service Registration is required for males born after 12/31/1959.
- You may be required to serve a probationary period.
- Subject to background/security investigation.
- Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
- Must pass pre-employment physical examination.
- Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
- English Language Proficiency. In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
- Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).
- Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.)