RN- Women's Health - PACT Care Coordinator

About the role

The Women's Health RN Care Coordinator is a member of the Patient Aligned Care Team (PACT) Core Team (Patient - Primary Care Provider and Clinical Care Associate) and Expanded Team (family - care giver - internal and community based resources) involved in providing veteran care and developing patient centered care plans. The Women's Health RN Care Coordinator collaborates with internal and external VA services to facilitate care transition and effectively meet Women Veteran patients' needs.

Responsibilities

• Demonstrating advanced clinical knowledge in assessing, planning, implementing, documenting, and evaluating care for the Woman Veteran across the continuum of care
• Triages and applies a collaborative team approach in identifying, analyzing, and resolving patient care problems
• Collaborates with patients to assess and identify needs, issues, care goals, and resources in critical factors for achieving desired outcomes for discharge, post hospital recovery, and health maintenance/wellness
• Maintains current knowledge of multidisciplinary resources, programs, and services, referring patients for community resources as appropriate
• Demonstrates ability to collaborate with all levels of services and disciplines
• Collaborates with patient, family, and care providers in all settings where care is being provided to evaluate and update changes in the patient-driven life plan and patient management
• Affords fiscal responsibility through monitoring utilization of resources
• Assists with the navigation of health care systems and intervenes or refers as needed to facilitate the achievement of patient outcomes
• Enhances patient self-management by providing information regarding all options, choices, and resources
• Provides care, respecting patient's personal values, cultural, and belief system
• Actively participates in care delivery with priority attention to patient preference
• Maintains confidentiality of all patient information, including electronic, print, and conversations
• Provides and promotes patient-driven care in a safe, efficient, and cost-effective manner, using evidence-based principles
• Promotes cost effective use of resources, effective least-expensive strategies expected in non-face-to- face approaches (including telehealth)
• Serves as a resource for patient and family rights, responsibilities, and decision-making information and processes
• Applies skills, such as motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life
• Supports the facility's EEO/affirmative action programs by executing assigned duties and responsibilities in a professional manner
• Provides age and population specific care and education
• Promotes health promotion and risk reduction strategies
• Works with interdisciplinary teams on care coordination, disease prevention, and population health management
• Maintains professional knowledge and skills based on current evidence-based practice
• Demonstrates leadership by sharing knowledge with colleagues or students to enhance professional growth, development, and practice
• Formally shares information gained from continuing education experiences within or across units and/or within the medical center
• Provides health care advice to patients and family members seeking advice, utilizing the nursing process and triage protocol and policies
• Completes work assignments within established time frames, adapts to changes or additions to work on projects
• Maintain and stay up to date on assigned competencies, including BLS
• Reports any problems with coworkers or patients or process issues to the Manager in a timely manner
• Completes mandatory training, updates, memo/minutes updates, and annual training updates
• Participates in process improvement activities and huddles

Requirements

• BLS Certification Required

Qualifications

• Basic Requirements: English Language Proficiency - 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)
• 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)
• 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/13000638Grade/Level Scope Education

Skills

• Advanced clinical knowledge in assessing, planning, implementing, documenting, and evaluating care for the Woman Veteran across the continuum of care
• Collaboration with patients to assess and identify needs, issues, care goals, and resources in critical factors for achieving desired outcomes for discharge, post hospital recovery, and health maintenance/wellness
• Maintaining current knowledge of multidisciplinary resources, programs, and services, referring patients for community resources as appropriate
• Demonstrates ability to collaborate with all levels of services and disciplines
• Collaborates with patient, family, and care providers in all settings where care is being provided to evaluate and update changes in the patient-driven life plan and patient management
• Affords fiscal responsibility through monitoring utilization of resources
• Assists with the navigation of health care systems and intervenes or refers as needed to facilitate the achievement of patient outcomes
• Enhances patient self-management by providing information regarding all options, choices, and resources
• Provides care, respecting patient's personal values, cultural, and belief system
• Actively participates in care delivery with priority attention to patient preference
• Maintains confidentiality of all patient information, including electronic, print, and conversations
• Provides and promotes patient-driven care in a safe, efficient, and cost-effective manner, using evidence-based principles
• Promotes cost effective use of resources, effective least-expensive strategies expected in non-face-to- face approaches (including telehealth)
• Serves as a resource for patient and family rights, responsibilities, and decision-making information and processes
• Applies skills, such as motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life
• Supports the facility's EEO/affirmative action programs by executing assigned duties and responsibilities in a professional manner
• Provides age and population specific care and education
• Promotes health promotion and risk reduction strategies
• Works with interdisciplinary teams on care coordination, disease prevention, and population health management
• Maintains professional knowledge and skills based on current evidence-based practice
• Demonstrates leadership by sharing knowledge with colleagues or students to enhance professional growth, development, and practice
• Formally shares information gained from continuing education experiences within or across units and/or within the medical center
• Provides health care advice to patients and family members seeking advice, utilizing the nursing process and triage protocol and policies
• Completes work assignments within established time frames, adapts to changes or additions to work on projects
• Maintain and stay up to date on assigned competencies, including BLS
• Reports any problems with coworkers or patients or process issues to the Manager in a timely manner
• Completes mandatory training, updates, memo/minutes updates, and annual training updates
• Participates in process improvement activities and huddles

Benefits

• 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)

Pay

• Competitive salary - regular salary increases - potential for performance awards

Schedule

• Monday - Friday - 8am - 4:30pm