Registered Nurse-Remote Patient Monitoring - Home Telehealth Rpm-Ht Care Coordinator

Summary
The Registered Nurse - Remote Patient Monitoring - Home Telehealth (RPM-HT) Care Coordinator is involved with the ongoing assessment, monitoring and case management of Veterans in their residential environment (or their environment of choice) and provides the appropriate information to providers and the healthcare system to enable 'just in time' care. Care Coordinators serve as case managers who utilize Home Telehealth technology in their practice of case management.
This job is open to

• Internal to an agency
  Current federal employees of this agency.

Clarification from the agency
First area of consideration - Current Permanent Tampa VA Medical Center employees including employees of the Veterans Canteen Service (VCS) and Community Based Outpatient Clinics (CBOCs) Second area of consideration - Current permanent VA Employees. Applicants must upload recent SF-50.
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Duties
The Care Coordinators/Case managers are in touch with Veterans in between their regular visits, advocating for the Veteran, ensuring the Veteran is receiving the care they need, and providing ongoing education and coaching so Veterans improve their ability to manage their chronic conditions.
The Care Coordinator engages in activities to support not only the Veteran but informal caregivers and volunteers, making the home the preferred place of care for the Veteran and Caregiver in a pivotal position in the care delivery.
Care Coordinator responsibilities may include:

• Providing initial and ongoing comprehensive assessment, including a review of systems that establish a comprehensive plan of care. The RN Care Coordinator performs a more focused assessment based on the condition for which the Veteran is enrolled. 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.
• Identifying, and intervening to address, potential exacerbations or complications in order to facilitate timely care in a clinic, emergency response or urgent care setting, or care in the community.
• Providing appropriate interventions, such as medication management, case management, and patient education. The RN Care Coordinator will focus more on health coaching and Veterans' self-management but also intervenes as clinically indicated.
• 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 communication and data exchange with community-based providers when there is co-managed care.
• Providing interdisciplinary consultation and interventions, such as with HBPC and other noninstitutional 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.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards
Work Schedule: 07:30am - 4:00pm; however, subject to change depending upon the needs of the service to include weekends/holidays.
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.
• Must be proficient in written and spoken English.
• 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
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.
Basic Requirements:

• United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 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). The approving official may authorize a waiver of the requirement for ACEN or CCNE accreditation of any degree in nursing provided the college or university has regional accreditation from an accrediting body recognized by the Department of Education at the time of the candidate's graduation and the composite qualifications of the applicant warrant such consideration. In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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.
• 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.

Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade:

• Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
• Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience.
• Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience.
• Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required.
• Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience.

Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required.
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: This position requires potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. Mechanical inpatient lifts are provided. The incumbent may be exposed to infected patients and contaminated materials and may be required to don protective clothing in isolation situations, operative or invasive procedures, or home settings. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs. Must complete annual Employee Health requirements, such as annual TB screening or testing, as a condition of employment. The incumbent who provides care in home settings or other off-site locations may be required to drive and/or ride in GSA-vehicles.
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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.
Additional information
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.

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