Registered Nurse - Home Health or Hospice - Remote

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Executes position responsibilities that demonstrate leadership, experience, and creative approaches in providing complex patient management.

Provides patient management, care coordination, and discharge/disposition planning for inpatient and outpatient settings.

Assists Veterans, family members, and care givers with receiving the most appropriate options and services to meet their complex health care needs. 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 to include assuring services interface within the VA and Community Nursing Home (CNH) programs to provide continuity of care to patients.

Performs clinical nursing review of medical records and on-site visits of patients who are residing in non-VA, community-based nursing homes to meet the long-term care needs of Veterans requiring a facility setting.

Possesses knowledge of utilization management processes, clinical documentation requirements, current standards of care, and compliance guidelines.

Reviews and assists in patient referrals across the continuum of care to ensure continuity of qualified, comprehensive care.

Participates as needed in the discharge planning assessment and implementation of community health services, to include nursing care, hospice, adult day health services, respite services, and activities required to successfully transition the patient to the appropriate non-acute care setting.

Performs follow-up and oversight visits to the Veteran after admission to the CNH to ensure that adequate and safe care is being provided while under VA contract.

Advocates for holistic care through patient/family education and provider interaction and implements an educational plan to meet the patient care needs.

the on-site visit will be completed monthly, no more than every 45 days, or more frequently as determined by the CNH Review and/or Oversight team.

Completes on-site assessments that include a review of the CNH medical records as they pertain to Veterans under VA contract or VCA, direct, face-to-face contact with the veteran, and engagement with CNH facility staff.

Documentation of on-site resident assessment visits is required to be completed via the nationally standardized CNH On-Site Resident Assessment Note Template, completing all required fields within seven business days.

Brings any imminent risks to health or safety immediately to the attention of the CNH Administration/Over-Site Committee.

Identifies and documents any quality oversight concerns, best practices, or positive observations and assists with information gathering for discussion with the CNH with the CNH Over-Site Committee as part of the CNH annual facility assessment and waiver process.

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

Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)

Work Schedule: Monday to Friday, 8am to 4:30pm or as needed by facility.

Telework: Ad-hoc.

Relocation/Recruitment Incentives: Not authorized

Permanent Change of Station (PCS): Not Authorized.