Registered Nurse - Home Telehealth Case Manager

Home Telehealth Registered Nurse (RN) Case Manager

Functions or Scope of Assigned Duties:

The Home Telehealth (HT) Registered Nurse (RN) Case Manager executes position responsibilities that demonstrate leadership, experience, and creative approaches to the management of complex patient care. Care will be provided in the least restrictive, most cost-effective manner. HT is a program that applies care and case management principles to coordinate care using health informatics, disease management and HT technologies to facilitate access to care and to improve the health of Veterans with the specific intent of providing the right care, in the right place, at the right time. The Home Telehealth (HT) Registered Nurse (RN) Case Manager works to improve clinical outcomes and access to care while reducing complications, hospitalizations, and clinic or emergency room visits for Veterans in post-acute care settings and high-risk patients with chronic and mental health disease. The Home Telehealth (HT) Registered Nurse (RN) Case Manager provides initial and ongoing comprehensive assessment to include a review of systems which establishes a comprehensive plan of care. Triages and assesses all data received from HT patients such as vital signs, reported symptoms and question responses. The Home Telehealth (HT) Registered Nurse (RN) Case Manager identifies and intervenes for potential exacerbations of complications to facilitate timely care in Patient Aligned Care Team (PACT) clinic, Emergency Department (ED)/Urgent Care (UC), and or/care in the community. The Home Telehealth (HT) Registered Nurse (RN) Case Manager provides communication and data exchange with community-based providers when there is co-managed care. Provides interdisciplinary consultation and interventions such as with Home Based Primary Care (HBPC) and other non-institutional care programs and venues, Mental Health (MH), Social Work (SW), Pharmacy, Nutrition, etc. The Home Telehealth (HT) Registered Nurse (RN) Case Manager identifies behaviors that support self-management and identify gaps therein. Provides health care coaching, patient education, and motivational counseling. Communicates and facilitates with the interdisciplinary team regarding progress to goals; patterns or trends of data, symptoms or findings; concerning findings; need for provider assessment and/or interventions. The Home Telehealth (HT) Registered Nurse (RN) Case Manager provides peers with informal constructive feedback for improvement. Fosters a safe and supportive environment conducive to the professional development of healthcare professionals. Contributes professional nursing perspectives in discussions with the interdisciplinary team. Partners with others to effect change and produce optimal outcomes. The Home Telehealth (HT) Registered Nurse (RN) Case Manager supports colleagues through knowledge sharing to provide safe, quality nursing care. Shares educational findings, experiences, and ideas with peers. Questions clinical practices for the purpose of providing evidence-based care. Participates in activities and strategies to sustain an evidence-based practice culture.

Supervisory Controls: The incumbent is responsible to the assigned rating and approving supervisors and is accountable to the Associate Director of Patient Care Services (ADPCS). Dimensions of Nursing Practice: Leads professional practice using the nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) to improve evidence-based and/or data-driven outcomes for an identified patient population and/or specialized areas within immediate practice setting Customer Services Requirements: The incumbent meets the needs of the Veteran and as appropriate the Veteran's Family, caregiver and/or significant other, the Veteran's representative, visitors to the VA facilities, all VA staff and other customers while supporting VA missions. The incumbent handles conflict and problems in dealing with any consumer group appropriately and in a constructive manner.

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

Pay Scale: NG42

Work Schedule: Full Time (Rotational Shifts)

Telework: Not eligible for Telework

Relocation/Recruitment Incentives: Not authorized

Permanent Change of Station (PCS): Not authorized