Registered Nurse - Home Telehealth Care Coordinator

Veterans Health Administration, Department of Veterans Affairs; Danville (IL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Paid Time Off

Federal benefits package

Job summary

Veterans Health Administration, Department of Veterans Affairs, is seeking a Remote Patient Monitoring Home Telehealth Registered Nurse Care Coordinator. The nurse will lead care coordination using informatics to improve access and outcomes for Veterans in post-acute and high-risk populations.

The role emphasizes assessment, triage, care planning, and collaboration with HBPC, MH, SW, Pharmacy, and Nutrition to deliver patient-centered care and to support self-management and education.

Qualifications

• English language proficiency required for direct patient care.
• Nursing degree from ACEN/CCNE accredited program or foreign equivalent.
• State license required upon completion of nursing program; licensure can be obtained and converted.
• Foreign graduates need degree equivalency validation (ICD) to warrant appointment.

Responsibilities

• Perform initial and ongoing comprehensive assessments to plan care.
• Triage and assess data from HT patients and coordinate timely care.
• Intervene for potential exacerbations and coordinate with PACT/ED/UC and community.
• Provide health coaching, patient education, and motivational counseling.
• Collaborate with interdisciplinary team to support self-management and outcomes.
• Foster a safe environment and share knowledge for safe nursing care.

Skills

English proficiency

Education

RN nursing degree (ACEN/CCNE approved)

State RN license upon graduation

Foreign nursing education equivalency validation

Job description

Summary

Remote Patient Monitoring (RMP) Home Telehealth (HT) Registered Nurse Care Coordinator executes position responsibilities that demonstrates leadership - experience - and creative approaches. HT is a program that applies care and case management principles to coordinate care using health informatics - disease management and HT technologies to facilitate access to care and to improve the health of Veterans with the specific intent of providing the right care - in the right place - at the right time.

Qualifications

Basic Requirements:

• English Language Proficiency
• In accordance with 38 U.S.C. 7403(f) - no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English
• Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE)
• OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program
• Upon achievement of a State license - the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program
• (Reference VA Handbook 5005 - Appendix G6)
• OR In cases of graduates of foreign schools of professional nursing - possession of a current - full - active - and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program
• Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD)
• Current - full - active - and unrestricted registration as a graduate professional nurse in a State - Territory or Commonwealth (i.e. - Puerto Rico) of the United States - or the District of Columbia
• Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements - but do not possess the required licensure - may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification
• Grade Determinations: The following Scope - Education and Dimension criteria must be met in determining the grade assignment of candidates - and if appropriate - the level within a grade
• The Dimension requirements (Practice - Veteran/Patient Driven Care - Leadership - Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/13093633
• Grade/Level Scope Education Nurse I - Level I Delivers fundamental - knowledge-based care to assigned clients while developing technical competencies
• An Associate Degree (ADN) or Diploma in Nursing - with no additional professional nursing required
• Nurse I - Level II Demonstrates integration of biopsychosocial concepts - cognitive skills and technically competent practice in providing care to clients with basic or complex
• An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I - Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required
• Nurse I - Level III Demonstrates proficiency in practice based on conscious and deliberate planning
• Self-directed in goal setting for managing complex client situations
• An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I - Level 2
• OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I - Level 2
• OR a MSN and no additional professional nursing experience
• OR a Master's degree in a *related field with a BSN and no additional professional nursing experience
• Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• A BSN with 2 years of professional nursing equivalent to Nurse I - Level 3
• OR an MSN with one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Doctoral degree in Nursing with no professional nursing experience
• OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience
• Nurse III Executes position responsibilities that demonstrate leadership - experience and creative approaches to management of complex client care beyond the immediate practice setting
• MSN and 2 years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Master's degree in *related field with BSN and two years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• *Note: Foreign education programs/degrees are not creditable as related degrees
• Preferred Experience: 3-5 years nursing experience PACT - case management or certification preferred BSN preferred Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: This position includes a level of physicality normally associated with duties performed by nurses such as direct patient care - and potentially long periods of walking - standing - sitting - moderate lifting - repeated bending - or kneeling.

Duties

• The Home Telehealth RN works to improve clinical outcomes and access to care while reducing complications - hospitalizations - and clinic or emergency room visits for Veterans in post-acute care settings and high-risk patients with chronic and mental health disease
• Provides initial and ongoing comprehensive assessment to include a review of systems which establishes a comprehensive plan of care
• Triages and assesses all data received from HT patients such as vital signs - reported symptoms and question responses
• Identifies and intervenes for potential exacerbations of complications to facilitate timely care in Patient Aligned Care Team (PACT) clinic - Emergency Department (ED)/Urgent Care (UC) - and or/care in the community
• Provides communication and data exchange with community-based providers when there is co-managed care
• Provides interdisciplinary consultation and interventions such as with Home Based Primary Care (HBPC) and other non-institutional care programs and venues - Mental Health (MH) - Social Work (SW) - Pharmacy - Nutrition - etc
• Identifies patients' knowledge - health factors - skills - and behaviors that support self-management and identify gaps therein
• Provides health care coaching - patient education - and motivational counseling
• Communicates and facilitates with the interdisciplinary team regarding progress to goals
• patterns or trends of data - symptoms or findings
• concerning findings
• need for provider assessment and/or interventions
• Provides peers with informal constructive feedback for improvement
• Fosters a safe and supportive environment conducive to the professional development of healthcare professionals
• Contributes professional nursing perspective in discussions with the interdisciplinary team
• Partners with others to effect change and produce optimal outcomes
• Supports colleagues through knowledge sharing to provide safe - quality nursing care
• Shares educational findings - experiences - and ideas with peers
• Other assigned duties
• 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 - 7:30 am - 4:00 pm Telework: Not Available Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized