Summary The RN Care Manager is an integral part of the patient-aligned care team (PACT) who uses the nursing process and evidence-based practice to collaborate with the Teamlet and expanded Team (family/caregiver, internal and community-based services involved in providing care to the patient) in developing the patient driven care plan for life. The RN Care Manager will work intermittently at the Community Based Outpatient Clinics (CBOC). Responsibilities The Community-Based Outpatient Clinic (CBOC) offers a wide range of services to veterans living within the county and surrounding areas. The CBOC addresses preventive health care, health maintenance needs, and primary care to eligible veterans. The CBOC also offers Mental health and Social Work services. Specialty services include but are not limited to: Audiology, Podiatry, and Nutrition. The RN Care Manager Nurse provides care management for patients with complex needs, addressing medical, mental health and psychosocial needs in a holistic manner, working collaboratively with multiple disciplines. Duties include: Identifies physiological, psychological, social and environmental variables affecting the functional status of the patient. Identifies current coping mechanisms and support systems and their effectiveness. Identifies current level of knowledge and skill of patient/significant other(s) in management of health care. Documents on approved VA forms/computer programs. Determines nursing diagnoses based on analysis of assessment data. Plans interventions which promote health. Develops teaching plans based on assessment of individual needs. Plans alternative interventions for patients with unique needs. Assures implementation of the plan of care. Assesses patient's ability to comply with the prescribed medical and therapeutic regimen Administers medications and treatments as ordered. Assists providers with procedures as needed. Assists with orientation of new staff. Assigns staff duties in accordance to their skill sets and the needs of the clinic. Role models the nurse as a professional who maintains a high standard of practice in giving direct care to patients with complex needs. Assists staff as needed in providing care for identified patients and families. Provides individualized instruction or directs nursing staff in teaching specific content/skill to patients/significant others/caregivers. Prepares professional clinical documentation of patient care and, in conjunction with the Nurse Manager, holds nursing staff accountable for same. Evaluates services rendered and the patient's response to the plan of care. Mutually, with professional colleagues, monitors the patient response and makes needed revisions. Provides professional leadership regarding nursing standards and services. Participates with interdisciplinary team and families in exploring and resolving as much as possible the ethical dilemmas that arise in the care of individuals with the complex problems associated with age. Serves as a consultant throughout the Medical Center for clinical care problems related to the needs of patients. The nurse is expected to take responsibility for attending in-services and continuing education activities and continued progression in knowledge and skills in medicine/surgical care nursing practice. Identifies and participates in quality improvement projects. Other duties or tasks as assigned by the Nurse Manager/Clinical Director or designee. 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: Varies, 08:00-16:30 Intermittent Telework: Ad-hoc Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required Requirements Conditions of Employment 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. You may be required to serve a probationary period. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details. 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/12461003. 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. Preferences: Patient-Aligned Care Team (PACT) - Primary Care experience. Salary for this position ranges dependent upon applicant qualifications Grade 1: $149,816-$199,250 annually Grade 2: $172,288-$221,900 annually Grade 3: $189,516-$221,900 annually Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: The physical requirements of this position include lifting, prolonged standing, frequent bending and stooping, walking, reaching, and repetitive motion. Heavy Lifting (45 lbs and over); Heavy Carrying (45 lbs and over); Straight Pulling (up to 1 hour); Pushing (1 - 2 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (up to 3 hours); Standing (up to 3 hours); Repeated bending (up to 1 hour); Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16"; Hearing (aid permitted). The mental/sensory requirements include recall, reasoning, problem-solving, hearing, speaking clearly, writing, keyboarding, reading, and logical thinking. The environment's pace can vary from steady to a fast pace requiring handling of multiple priorities, frequent, sometimes intense customer interactions, and the ability to adapt to frequent changes in a sometimes noisy environment. There may be the need to use personal protective equipment to prevent exposure to disease, illness and hazardous materials. Education IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions. This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.