The Home Telehealth Care Coordinator Lead RN is assigned to the Primary Care Division, Vancouver campus of VA Portland Health care System. The incumbent provides supervision (guidance) to program staff involved in the day-to-day clinical operations of care coordination service delivery. Provides leadership in application of the nursing process, identifies resources, critical factors for achieving desired outcomes for discharge, post hospitalization recovery and health maintenance/improvement.
Duties are but not limited to:
Provides initial and ongoing assessment of patients to identify needs and issues regarding goals and appropriate resources necessary for care management.
Provides supervision (guidance) to program staff involved in the day-to-day clinical operations of care coordination service delivery. This includes assuring accuracy of information provided in the forms of progress notes, reports, presentations, and briefings on program patients and operations.
Provides leadership in application of the nursing process and identifies resources and critical factors for achieving desired outcomes for discharge, post hospitalization recovery and health maintenance/improvement.
Sets clinical care goals, short and long term, in collaboration with patient, provider(s), and family members.
Functions as a systems coordinator for the plan of care; monitors progress through the expected hospital course and intervenes as appropriate to facilitate achieving patient outcomes within anticipated timeframes.
Coordinates care and discharge planning with the patient's primary care provider and team.
Collaborates with patient and care providers in any and all settings where care is being provided to evaluate and update changes in the therapeutic plan of care and patient management.
Recognizes complex situations that impact patient care and intervenes using sound judgment, professional attitude, and appropriate channels.
Recognizes impact of age-specific care needs and incorporates this into the assessment process. Also, incorporates these age-specific needs into care as reflected by modification of treatment plans.
Maintains a working knowledge of resources available in the community.
Appropriately documents own interventions and oversee appropriate health team documentation of patient care.
Assesses patient for use of appropriate telehealth, devices, follows procedures for ordering or leasing of equipment, documents installation and education in computerized patient record.
Develops and leads Care Coordination Home Telehealth (CCHT) Teams to improve organizational and staff performance.
Identifies opportunities for improvement and participates in performance improvement activities related to the CCHT Program and local medical center quality improvement process.
Evaluates need and initiates interdisciplinary ad hoc committees/process action teams for constructive problem solving.
Tracks and trends issues related to care delivery and role implementation.
Develops and implements interdisciplinary standards of practice and care at the station level for the Care Coordinator role.
Participates in VISN-wide standards development for the role.
Develops and implements an educational plan to enhance program development and professional performance.
Develops, coordinates, and presents educational programs toward improving productivity, patient outcomes and treatment modalities.
Facilitates educational opportunities for program staff to meet their individual goals.
Leads and works collaboratively with interdisciplinary groups in a cohesive manner.
Communicates effectively both verbally and in writing with program staff, patients, families/significant others, health team members, and local medical center leadership.
Protects printed and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, federal regulations, VA statutes and policy, and VHA policy.
Protects the data from unauthorized release or from loss, alteration, or unauthorized deletion.
Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the computer access agreement that the incumbent signs.
Reports all known information security incidents or violations to the supervisor and/or the Information Security Officer immediately.
Reports all known privacy incidents or violations to the Privacy Officer immediately.
Embraces a continuous culture of safety for veterans, their families, visitors, and other employees.
Work Schedule: Varying tours ranging from 07:00 am - 5:00 pm Monday - Friday
Financial Disclosure Report: Not required
Job family (Series)
Conditions of Employment
You must be a U.S. Citizen to apply for this job
Designated and/or random drug testing required
Selective Service Registration is required for males born after 12/31/1959
You may be required to serve a probationary period
Subject to a background/security investigation
Must be proficient in written and spoken English
Selected applicants will be required to complete an online onboarding process
Must pass pre-employment physical examination
United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
Graduate of a school of professional nursing approved by the appropriate State-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). 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 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's 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 year's of nursing practice/experience; OR a Doctoral degree and approximately 2-3 year's of nursing practice/experience.
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.
Preference: Bachelor of Science Degree in Nursing
Physical Requirements: The population of male and female veterans served ranges from the adult, age 18, to the elderly adult, age 65 and over. This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. Moderate lifting of 15-44 pounds; Straight pulling for 0.5 hours; Pushing for 0.5 hours; Reaching above shoulder; Walking for 4 hours; Standing for 4 hours; Kneeling for 0.5 hours; Ability for rapid mental and muscular coordinating simultaneously; Depth perception; Ability to distinguish basic colors; Hearing (aid permitted); Mental and emotional stability; Moderate carrying of 15-44 pounds; Use of fingers, both hands required.
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.
CBOC duty location options: West Linn; Bend; Fairview; Salem; Hillsboro; The Dalles; North Coast; Vancouver.
Telework for this position may be offered.
Annual leave shall accrue for full-time Nurses, and Nurse Anesthetists at the rate of 8 hours for each full biweekly pay period.
This job opportunity announcement may be used to fill additional vacancies.
It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.
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.
Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.
If you are unable to apply online view the following link for information regarding an Alternate Application.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, résumé, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.
NOTE: Candidate's education and length of nursing practice (experience) will be considered by a Nurse Professional Standards Board in determining the grade and salary of the applicant selected. The recommended salary may be at any point in the range listed for this vacancy.
Experience as an RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following four dimensions of nursing: Practice, Professional Development, Collaboration and Scientific Inquiry. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Background checks and security clearance
Drug test required
Position sensitivity and risk
Non-sensitive (NS)/Low Risk
Trust determination process
To apply for this position, you must provide a complete Application Package which includes:
VA Form 10-2850a - Application for Nurses and Nurse Anesthetists can be found at: http://www.va.gov/vaforms/search_action.asp?FormNo=2850&tkey=&Action=Search.
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), etc.
DD-214/ Statement of Service
Disability Letter (Schedule A)
Disability Letter (VA)
VA Application 10-2850a
Separation Notice (RIF)
SF-50/ Notification of Personnel Action
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.
This job is open to
U.S. citizens, nationals or those who owe allegiance to the U.S.