Registered Nurse - PACT Care Manager

U.S. Department of Veterans Affairs; Atlanta (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

The U.S. Department of Veterans Affairs seeks a Nurse for Primary Care (PACT RN Care Manager). This open continuous vacancy focuses on care coordination for high-risk patients, using evidence-based guidelines to craft patient-driven plans in collaboration with interdisciplinary teams and families.

Responsibilities include education, coaching, and ensuring smooth care transitions. Telework is not available; full-time in-person work is required with a strong focus on population health and outcome

Qualifications

• English proficiency in written and spoken form per VA standards.
• Graduate of a nursing program approved by accrediting bodies (ACEN/CCNE).
• Bridge program in nursing may allow RN licensure prior to completion.
• Temporary appointment possible upon state licensure prior to bridge completion.
• Foreign graduates require degree equivalency validation.
• Current full and unrestricted RN license in any US state or DC.

Responsibilities

• Serve as primary point of contact for care management for an assigned patient panel, focusing on high-risk patients and care transitions.
• Develop, implement, and update individualized, patient-driven care plans with interdisciplinary teams and families.
• Provide health education, coaching, and counseling emphasizing self-management and wellness.
• Collaborate with VA and community resources to assess needs and support comprehensive patient care.
• Participate in performance improvement activities and use patient registries for population health management.

Skills

English proficiency

Nursing license

Education

Nursing degree (BSN/ADN/Diploma)

Accredited nursing program (ACEN/CCNE)

Bridge program in nursing (MSN bridge)

Foreign nursing education equivalency evaluation

Current unrestricted RN license in US

Job description

Summary

This is an open continuous announcement until September 30 - 2026. Qualified applicants will be referred and considered as vacancies become available.

Qualifications

• 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/13070900
• 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 Master's degree in nursing (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
• Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: You will be asked to participate in a pre-employment examination or evaluation as part of the pre-employment process for this position Questions about physical demands or environmental factors may be addressed at the time of evaluation or examination.

Duties

• The primary duties for the PACT RN Care Manager include - but are not limited to: Serve as the primary point of contact for care management and coordination for an assigned patient panel - focusing on high-risk patients - care transitions - and population health strategies utilizing data resources
• Use nursing expertise - evidence-based guidelines - and standardized protocols to develop - implement - and update individualized - patient-driven care plans in collaboration with interdisciplinary teams and patients/families
• Provide health education - coaching - and counseling to patients and families - emphasizing self-management - prevention - wellness - and shared decision-making
• Work actively with the PACT Team - internal and external VA services - and community-based resources to assess patient needs - support care transitions - and ensure comprehensive patient care
• Participate in performance improvement activities - utilize patient registries and data resources for population health management - and monitor outcomes to identify care gaps and enhance patient wellness
• Maintain current knowledge of multidisciplinary resources and programs - refer patients as appropriate - and serve as a resource for navigating the healthcare system and processes
• Assess patients for telehealth and home monitoring devices - utilize VA Video Connect - Document all patient interactions and interventions in the patient record - complete encounters for workload credit - and support compliance with standards and nursing practice aligned with Primary Care ICC and CAN Score management
• 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: full-time - multiple tours available Compressed/Flexible: May be available Telework: Not available Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not authorized EDRP: Position(s) listed under this Open Continuous Announcement (OCA) MAY be eligible for the Education Debt Reduction Program (EDRP) - a student loan payment reimbursement program
• Applicants selected for an EDRP-eligible position will be notified in their conditional job offer
• The selectee must meet specific eligibility requirements per VHA policy and submit an EDRP application within four months of appointment
• Program approval - award amount (up to $200 -000) - and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application
• Former EDRP participants are ineligible to apply
• Permanent Change of Station (PCS): Not authorized PCS Appraised Value Offer (AVO): Not authorized