Registered Nurse

Registered Nurse (RN) Care Manager

The Registered Nurse (RN) serves as a Patient Aligned Care Team (PACT) Registered Nurse Care Manager (RNCM) within Outpatient Primary Care. Duties include, but are not limited to:

• Provides fundamental, knowledge-based, coordinated nursing care to an assigned panel of patients within the Primary Care PACT.

• Provides primary care coordination, including transitions of care, preventive care, chronic disease management, and Veteran-centered nursing care.

• Provides care through multiple modalities, including face-to-face visits, virtual encounters, secure messaging, and telephone-based services.

• Uses evidence-based guidelines and population health tools to assist in identifying and managing high-risk and chronically ill patients.

• Provides chronic disease management, preventive health services, patient education, health coaching, and support for Veteran-centered health goals.

• Coordinates same-day patient needs and post-discharge care, including procedures, labs, follow-up, pre-visit preparation, clinical reminders, and referrals.

• Connects Veterans with appropriate services, specialty care, and interdisciplinary team resources.

• Participates in daily huddles and collaborates with PACT members and extended care support teams to coordinate patient care.

• Provides individualized care, health coaching, motivational interviewing, and ongoing management for patients with chronic and ambulatory care-sensitive conditions.

• Assists with coordinating smooth transitions between acute and ambulatory care settings.

• Supports patient self-management, goal setting, health promotion, and overall wellness.

• Collaborates with PACT team members to promote access, continuity, patient experience, and quality outcomes.

• Uses VHA panel management tools and team metrics to identify care gaps and support proactive, high-quality primary care delivery.

• Provides patient and family education and advocates for Veterans' needs to improve patient outcomes and wellness.

• Performs other related duties appropriate to the grade and assignment as directed.

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; 8:00am - 4:30pm

Telework: Ad-hoc - as determined by the agency

Virtual: This is not a virtual position.

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