Registered Nurse-State Veterans Home Coordinator

Job TitleSVH Care CoordinatorJob DescriptionHelps Provides patient management, care coordination, and discharge/disposition planning for inpatient and outpatient settings. The SVH Care Coordinator assists Veterans, family members, and caregivers with receiving the most appropriate options and services to meet their complex health care needs. This includes, but is not limited to, acute, chronic, multiple, complex, catastrophic, or life-threatening illnesses; combat stress, residuals of traumatic brain injury; community adjustment; addictions and other health problems. Coordinates care with multiple providers across all levels and sites of care. Facilitates communication and collaboration between VA programs, SVH staff, and interdisciplinary teams. Influences care outcomes through clinical consultation, systems level thinking, and advocacy. Ensures adherence to established policies, procedures, and contractual agreements. Coordination includes assuring services interface within the Veterans Affairs (VA) and community programs to provide continuity of care to patients. Duties include but are not limited to:Serves as a clinical resource and consultant to SVH staff and VA teams regarding Veteran care needs, standards of practice, and regulatory requirements.Reviews and evaluates clinical care delivery, documentation, and outcomes to ensure alignment with VA expectations and quality benchmarks.Monitors quality indicators (e.g., hospital transfers, infections, falls, pressure injuries) and collaborates with SVH leadership to address trends and implement performance improvement initiatives.Facilitates care coordination and communication between SVHs, VA Medical Centers, and community providers to ensure seamless transitions and continuity of care.Provides education and guidance to SVH staff, Veterans, and families on care processes, VA benefits, and available resources.Supports compliance with VA contracts, state regulations, and accreditation standards through consultation, audits, and participation in surveys or reviews.Utilizes data systems and population health tools to analyze trends, inform decision making, and improve system-level outcomes.Advocates for Veterans to ensure access to appropriate services, quality care, and a safe living environment.Promotes a collaborative, respectful partnership with State Veterans Home staff.Applies clinical judgment to support decision-making while maintaining clear role boundaries as a consultant.Contributes to ongoing quality improvement, regulatory readiness, and Veteran centered care initiatives.VA offers a comprehensive total rewards package: VA Nurse Total RewardsPay: Competitive salary, regular salary increases, potential for performance awardsPaid 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 VAInsurance: 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 territoryWork Schedule: Intermittent between the hours of 7:30 am - 4:00 pm, Monday-Friday, depending on needs of the facility. Subject to change based on the needs of the facility.Telework: Not AvailableVirtual: This is not a virtual position.Relocation/Recruitment Incentives: Not AuthorizedPermanent Change of Station (PCS): Not Authorized