Registered Nurse - Patient Aligned Care Team

Registered Nurse Care Manager

The Registered Nurse Care Manager (RNCM) is responsible for organizing and directing team members to achieve desirable patient outcomes through day-to-day and/or telephonic case management. The RNCM functions in the Primary Care Clinic which utilizes a Patient Aligned Care Team (PACT) model. The RNCM uses the nursing process and evidence-based practice to collaborate with the Core Team in developing the patient-driven care plan. Duties may include but are not limited to:

• Demonstrates clinical knowledge in assessing, planning, implementing documenting and evaluating care for a designated group of patients across the continuum of care.
• Triage and apply a collaborative team approach in identifying, analyzing and resolving patient care problems.
• Collaborates with patients to assess and identify needs, issues, care goals and resources in critical factors for achieving desired outcomes for discharge, post hospital recovery and health maintenance/wellness.
• Maintains current knowledge of multidisciplinary resources, programs and services, referring patients for community resources as appropriate.
• Utilizes problem-solving methodologies and advances clinical knowledge to resolve system and/or processes that impact patient care.
• Assists with navigation of health systems and intervenes or refers as needed to facilitate the achievement of patient outcomes.
• Provides care, respecting patient's personal values, cultural and belief systems.
• Assists with the development, assessment, and monitoring/evaluation of comprehensive plans of care to ensure efficient, effective, and coordinated care in meeting and promoting standards of wellness.
• Coordinates an interdisciplinary approach to assure physical, psycho-social, and environmental needs and resource delivery to achieve patient goals.

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, 7:30am-4:00pm.

Compressed/Flexible: Available.

Telework: Not available.

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not authorized.

EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact View email address on click.appcast.io, the EDRP Coordinator for questions/assistance. Learn more

Permanent Change of Station (PCS): Not authorized.