Registered Nurse - Remote Patient Monitoring Home Telehealth Case Manager
: Job Details :

Remote Patient Monitoring (RPM) Home Telehealth (HT) Registered Nurse

The Remote Patient Monitoring (RPM) Home Telehealth (HT) Registered Nurse demonstrates leadership, experience, and creative approaches to the management of complex patient care. Provides care in the least restrictive,most cost-effective manner. HT applies care and case management principles to coordinate care using health informatics, disease management and HT technologies to improve the health of Veterans with the intent of providing the right care, in the right place, at the right time.

Responsibilitiesinclude, but are not limited to:

• Works to improve clinical outcomes and access to care while reducing complications, hospitalizations, and clinic or emergency room visits for Veterans in post-acute care settings and high-risk patients with chronic and mental health disease.
• Provides initial and ongoing comprehensive assessment to include a review of systems which establishes a comprehensive plan of care.
• Triages and assesses all data received from HT patients such as vital signs, reported symptoms and question responses.
• Identifies and intervenes for potential exacerbations of complications to facilitate timely care in Patient Aligned Care Team (PACT) clinic, Emergency Department (ED)/Urgent Care (UC), and or/care in the community.
• Provides communication and data exchange with community-based providers when there is co-managed care.
• Provides interdisciplinary consultation and interventions such as with Home Based Primary Care (HBPC) and other non-institutional care programs and venues, Mental Health (MH), Social Work (SW), Pharmacy, Nutrition, etc.
• Identifies patients' knowledge, health factors, skills, and behaviors that support self-management and identify gaps therein.
• Provides health care coaching, patient education, and motivational counseling.
• Communicates and facilitates with the interdisciplinary team regarding progress to goals; patterns or trends of data, symptoms or findings; concerning findings; need for provider assessment and/or interventions.
• Fosters a safe and supportive environment conducive to the professional development of health care professionals.
• Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups, and populations.
• Responsible for the documented outcomes at the program or service level.
• Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level within a facility.
• Responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care.
• Assesses, plans, implements, and evaluates care based on age specific components.
• Assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care.
• Provides care and counseling of persons in the promotion and maintenance of health and prevention of illness and injury based upon the nursing process which includes systematic data gathering, assessment, appropriate nursing judgment, and evaluation of human responses to actual or potential health problems through such services as case finding, health teaching, health counseling; provision of care supportive to or restorative of life and well-being; and executing medical regimens.
• Follows procedures per established policies and guidelines.
• Influences care outcomes by collaborating with members of the interdisciplinary team.
• Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care.

VA offers a comprehensive total rewards package:

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: 80 hours biweekly; Monday-Friday; 8-hour shifts, negotiable between hours of 7:00 a.m. - 4:30 p.m.

Telework: Not available

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not authorized

Permanent Change of Station (PCS): Not authorized

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.

Acceptable form(s) of identification will be required to complete pre-employment requirements.

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 examination.

Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).

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.

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.

Preferred Experience:

Extensive clinical experience in areas as primary care, geriatrics, and/or chronic disease management. Strong assessment and critical thinking skills. Comfort and proficiency using computers and healthcare software applications. Experience in patient education and coaching with the ability to explain complex health information clearly. Excellent verbal and written communication skills. Ability to manage time effectively.

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: