Summary

The Remote Patient Monitoring (RPM) Home Telehealth (HT) Nurse Case Manager executes position responsibilities that demonstrate leadership - experience - and creative approaches to the management of complex patient care. HT is a program that coordinate care using health informatics - disease management and HT technologies to facilitate access to care and to improve the health of Veterans with the specific intent of providing the right care - in the right place - at the right time

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/12751700
• 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/
• Physical Requirements: Moderate lifting (15-44 lbs)
• Moderate carrying (15-44 lbs)
• Straight pulling (0.5 hrs)
• Pushing (0.5 hrs)
• Reaching above shoulder
• Use of fingers
• Both hands required
• Walking (4 hrs)
• Standing (4 hrs)
• Kneeling (0.5 hrs)
• Ability for rapid mental and muscular coordination simultaneously
• Depth perception
• Ability to distinguish basic colors
• Hearing (aid may be permitted)
• Mental and emotional stability
• Environmental Factors: Working closely with others
• Preferred Experience: Preferred candidate has a BSN
• Experience in Care Coordination
• 2-3 years of nursing experience.

Duties

• Portland is a port city in the Pacific Northwest and the most populous city in the U.S. state of Oregon
• Situated in the northwestern area of the state at the confluence of the Willamette and Columbia rivers
• Portland is known for having the amenities of a major city (such as an international airport - an efficient public transit system - major league sports teams and many museums and art galleries) and the charms of a small city (such as plentiful arts and crafts fairs - independent bookstores and local traditions like the annual Rose Festival Parade)
• Rain or shine - you can take advantage of the city's proximity to nature by playing in the Willamette River - wandering through lush public parks and gardens - biking the city's 162 miles (261 km) of bike lanes and hiking trails both within city limits and in the nearby Columbia River Gorge
• Duties include - but not limited to: 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
• 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
• 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: Monday-Friday 0700-1730 (varying tours) Telework: Not available Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized