The RN Remote Patient Monitoring- Home Telehealth Care Coordinators are case managers and health coaches who are highly skilled and have specific training and competency in the use of disease management, health care informatics, and remote patient monitoring technologies. The RN emphasizes collaboration and engages in processes that assess, advocate, plan, implement, coordinate, monitor, and evaluate healthcare options and services to meet the needs of the individual Veteran.
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/12734548. 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/. Preferred Experience: Primary Care/Case Management experience Physical Requirements: The position involves considerable standing, walking, stooping, bending, reaching, lifting, and turning. It requires restraining confused patients, repositioning patients, assisting with transferring patients to Wheelchairs/stretchers/cars, and transporting them to other departments or facilities. Mechanical devices available and are required to be used for heavy or difficult to lift patients. The work may involve pushing or lifting weight in excess of 50 pounds and going up and down flights of stairs. The individual may be exposed to infected patients and contaminated materials and may be required to don protective clothing in isolation situations or operative/invasive procedures. This position requires visual acuity, good hearing, distinctive speech and manual dexterity. The position requires the nurse to work for periods of time with arms above shoulder level with neck in a fully flexed or extended position and the ability to physically control or protect his/herself from physically abusive patients.
Major Duties: Practice under the National, VISN 19, and VHASLC local guidelines supported by the Remote Patient Monitoring- Home Telehealth Manual, HT Documentation Clinical User Guide, and the OCC Telehealth Manual. The Home Telehealth RN Care Coordinator interfaces with a panel of rural or highly rural Veteran patients via computer to monitor daily responses from Veterans' home monitoring input devices. Providing initial and ongoing comprehensive assessment, including a review of systems that establish a comprehensive plan of care. The Care Coordinator identifies, analyzes, and prioritizes problems and interventions and sets appropriate measurable goals (i.e., Specific, Measurable, Attainable, Realistic, and Timely [SMART] goals). The treatment plan is an extension of the Veteran's primary care plan and is completed in collaboration with PACT, HBPC, mental health care, and other specialty care services, as appropriate for each Veteran enrolled in the program. Triaging and assessing all data received from RPM - HT patients, such as vital signs, reported symptoms, and question responses. The Care Coordinator will review daily responses each workday and contact Veterans about worrisome responses and trends, significant changes in condition, or changes in other specific data elements received, as clinically appropriate. Ideally, Care Coordinators should contact Veterans when responses indicate that an issue may be developing - in order to provide education, offer self-management tips, and assist with problem-solving - rather than waiting until a red alert signals that the situation may be out of control. Completes an assessment of patients who may have multiple and complex comorbidities that necessitate additional coordination of care and case management to ensure easily accessible, continuous, high-quality care across all settings. Provides ongoing professional assessment and case management to an adult population of predominantly (but not limited to) older male patients. Completes assessment and plan of care on assigned patients and provides individualized nursing care. Conduct ongoing reassessments to evaluate changes in patients' status. Identifying and intervening to address potential exacerbations or complications in order to facilitate timely care in a clinic, emergency response urgent care setting, or care in the community. Providing appropriate interventions, such as medication management, case management, and patient education. Completing protocol-based interventions as needed. Triaging incoming calls and concerns of Veterans or families, resolving those within their scope of practice, and routing others to interdisciplinary team staff or other services, as indicated. Providing interdisciplinary consultation and interventions, such as with HBPC and other non institutional care programs and venues, mental health, social work, pharmacy, nutrition, etc. Identifying patient knowledge, health factors, skills, and behaviors that support self management and identifying gaps. Providing health coaching, patient education, and psychosocial support. Documenting and communicating with PACT or specialty care service members about changes in status, progress toward goals, patterns or trends in data, symptoms or findings of concern, and need for provider assessment or intervention. Facilitating, documenting, and communicating treatment changes to the Veteran, as directed by providers, and providing a follow-up evaluation of the Veteran after changes are implemented. Providing support and guidance and reviewing changes in medications, goals, and the treatment plan with Veterans during and after transitions in care, such as after a hospital discharge. Assessing and analyzing outcome indicators and developing action plans for both individual Veterans and aggregate populations to enable continuous performance improvement. Participating in peer review of documentation for continuous performance improvement. Plans for discharge/transfer of patients, including completing discharge/transfer notes in CPRS. VA offers a comprehensive total rewards package: VA Nurse Total Rewards A Career At VA Salt Lake City Health Care System Can Take You Places (youtube.com) 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, 7:30am to 4:00pm Telework: Not Available Virtual: This is not a virtual position.