Registered Nurse - Community Care Coordinator

Veterans Health Administration; Martinsburg (WV); On-site; USD 71,000 - 136,000; Full time

Benefits offered by this job

Telework eligible

Job summary

U.S. Department of Veterans Affairs in Martinsburg, WV seeks a Registered Nurse - Community Care Coordinator to coordinate care options for Veterans, including community care, and to guide the Veteran through the consult process.

The RN will collaborate with the interdisciplinary team, ensure timely access to care, and adhere to VA care coordination standards. Telework is eligible; position details reflect VA's total rewards and federal benefits.

Responsibilities

• Demonstrates proficient nursing practice, planning and critical thinking.
• Assess, organize, facilitate and guide Veterans through care options including internal and community care.
• Serve as liaison to internal and community providers; manage Veteran care through consult process.
• Support timely access to care; refer and schedule Veterans to community care when appropriate.
• Coordinate care processes per IVC Field Guidebook; develop care coordination plan and review documentation.
• Adhere to VA mandated processes and health information systems for care coordination data.
• Utilize delegation to operate at highest level; share knowledge to ensure safe, quality care.
• Evaluate outcomes of care decisions; report program-level outcomes.

Job description

Registered Nurse - Community Care Coordinator

• Department: Department of Veterans Affairs

The Community Care (CC) Coordinator Registered Nurse (RN) is responsible for executing a streamlined approach to receiving, triaging, and directing timely, coordinated care. This position is with Care in the Community (CITC) in Martinsburg, WV.

Key Responsibilities

Major Duties include but not limited to: Demonstrates proficient practice and decision-making, deliberate planning, and critical thinking skills. Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care regulations, and Veterans Health Administration (VHA) standards and guidelines.

Uses nursing knowledge and systems theory to assess, organize, facilitate, and guide Veterans through their full range of care options including internal/direct care in Veterans Affairs (VA) and care in the community. Serves as a liaison to both internal and community providers and is responsible for managing the care of the Veteran throughout the consult process.

Supports the medical center's mission to improve timely access to care, ensure Veterans who want to receive care in the community are referred and scheduled into the community, and support the delivery of high quality, timely care to the Veteran receiving community services.

Works collaboratively within the Office of Integrated Veteran Care (IVC) to triage Request for Services (RFS) to coordinate care processes defined by the IVC Field Guidebook to include developing a care coordination plan, reviewing medical documentation from community providers, communication of care coordination needs, and supporting the Veteran through the completion of the episode of care.

Influence care outcomes by collaborating with members of the interdisciplinary team both within the Veterans Affairs (VA) and in the community. Complies with VA-mandated processes and use of health information solutions that serve to assess, document, exchange, and track care coordination information.

Utilize delegation of authority, if applicable, to function at their highest level of role performance and align high-quality care with key performance indicators to ensure practice standards meet patient care needs. Supports colleagues and other nurses through knowledge sharing to provide safe, quality nursing care. Fosters a safe and supportive environment conducive to the professional development of health care professionals.

Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups, and populations. Responsible for the documented outcomes at the program or service level. Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level within a facility.

Provides oversight and care coordination for Veterans with community care consults, RCT consults, Hospital Notification EOCs, Community Programs consults, and Home Health consults.

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, Day Shift Telework: Ad-Hoc Only.

Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized. Permanent Change of Station (PCS): Not Authorized.

Which agency is hiring for this position?

This position is with Veterans Health Administration, Department of Veterans Affairs.

What is the salary for this position?

The posted pay range is $70938 – $135855/yr.

Is this position remote or telework eligible?

This position is eligible for telework.

What is the application deadline?

Applications close on 2026-11-03.

Who is eligible to apply?

This position is open under the 'Public' hiring path.