Community Care Coordinator Nurse

Primary Purpose: Delivers fundamental knowledge-based care to assigned clients while developing technical skills. Assesses, plans, implements, and evaluates the effectiveness of the Veteran's care. Service to support delivery of high quality, timely care to the Veteran receiving services in the community. Assumes the responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care.

Major duties include but are not limited to: Responsible for executing a streamlined approach to receiving, triaging, and directing timely, coordinated care. Brings principles and theory with limited application of 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 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. Preferred Experience: Three or more years of nursing experience. At least one year in Care Coordination, Case Management, or Utilization Management. The ideal candidate possesses at least one year experience performing the following functions: Leading an integrated care team through providing clinical leadership and expertise on program processes and regulations. Demonstrating effective communication skills to collaborate and co-manage the patient's care with the multidisciplinary team in a cost-effective manner. Serving as lead care coordinator for the patient and following the standardized care coordination model, incorporating case management principles, as applicable. Facilitating care unique to the patients needs, monitoring, tracking, and intervening if necessary in the episode of care across the continuum. Performing clinical review of referrals for specialty care, to include identifying pertinent medical records and diagnostic results to include with referral. Applying knowledge related to policy guidelines, utilization review criteria, and current evidence based standards of care. Reviewing requests for continued care or higher level of care and composing clinical summary of requests to facilitate provider clinical review. 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, 0800 - 1630 Telework: Ad-Hoc Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical evaluation/examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). You may be required to serve a probationary period. Complete all application requirements detailed in the "Required Documents" section of this announcement.