Registered Nurse - Patient Aligned Care Team

PACT Registered Nurse Care Manager

Help build a rewarding nursing career where relationships, prevention, and coordinated care make a lasting difference for Veterans. As a PACT Registered Nurse Care Manager, you will partner with Veterans, families, primary care colleagues, specialty services, and extended care teams to create individualized plans that support wellness, strengthen self-management, and address needs before they become more complex. This role offers the opportunity to practice across in-person and virtual settings, contribute to seamless care transitions, and use evidence-based approaches to improve access, continuity, and the overall Veteran experience. Duties include, but are not limited to:

• Coordinate comprehensive primary care for an assigned panel of Veterans, aligning services with individual health goals, preferences, and clinical needs.
• Deliver preventive care, chronic disease management, and nursing interventions through face-to-face visits, telephone care, virtual encounters, and secure messaging.
• Facilitate smooth transitions between inpatient, specialty, community, and primary care settings, including timely post-discharge follow-up.
• Identify Veterans with rising or high-risk needs using population health tools, clinical indicators, and panel-management data.
• Coach Veterans in self-management, goal setting, and healthy behavior change through individualized education and motivational interviewing.
• Connect Veterans with specialty care, wraparound services, referrals, and interdisciplinary resources that support timely, coordinated treatment.
• Collaborate with PACT and extended care team members through daily huddles, pre-visit planning, and ongoing communication to improve access and continuity.
• Address care gaps by completing clinical reminders, coordinating laboratory and procedural needs, preparing patients for visits, and supporting follow-up care.

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 - 4:30am

Telework: Not Authorized

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not Authorized

Permanent Change of Station (PCS): Not Authorized

The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being.