Department Of Veterans Affairs Yuba City , CA 95991
Help Duties Summary
The Patient Aligned Care Team (PACT) RN Care Manager (RNCM) is a licensed professional RN who is assigned to a designated panel of patients within Primary Care. The PACT RNCM works in partnership with other team members, which includes the patient, to effectively and efficiently deliver and manage preventative, proactive, patient-driven care and chronic disease management and care needs. The RNCM demonstrates leadership in delivering efficient and continuous patient-driven holistic care.
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Demonstrates advanced clinical knowledge in assessing, planning, implementing, documenting, and evaluating care for a panel of patients across the continuum of care, recognizing the age related cognitive, physical, emotional, and chronological maturation needs of the adult and geriatric patient.
Participates in chronic disease management for panel in collaboration with provider. Engages in Shared Medical Appointments (SMA), Group visits, Team visits and/or RNCM visits.
Utilizes the Primary Care Almanac and PACT Metrics to address population health management issues and improve Team processes.
Triages and applies a collaborative team approach in identifying, analyzing, and resolving patient care problems.
Collaborates with ancillary team members and resources within the clinic to manage clinic access issues. This may include assisting other nursing staff with maintaining clinic flow.
Actively participates in Tele Primary Care
Promotes patient, family and team interactions, and problem solving by actively participating in interdisciplinary meetings to facilitate coordination and the achievement of identified goals.
Retains current knowledge of multidisciplinary resources, programs, and services, referring patients for community resources as appropriate.
Collaborate with patients to assess and identify needs, issues, care goals, and resources for achieving desired outcomes post hospital recovery and health maintenance/wellness by effectively using Motivational Interviewing and TEACH techniques.
Supports patient self-management by providing an ongoing relationship with the PACT with current information regarding all options, choices, and resources. Provides patient centered care while respecting patient's personal values, cultural, and belief system.
Utilizes approved Protocols and Guidelines to facilitate autonomy in providing care. Works at the top of scope of practice.
Manages patient care alerts in CPRS and secure messages in a timely, safe and effective manner.
Serves as a resource for patient and family rights, responsibilities, and decision-making information and processes.
Applies critical thinking and analytical skills to identify barriers for optimal patient care delivery and utilizes processes improvement strategies to correct or improve current state.
As needed, provides back-up coverage for other team members and other PACT RNCM within the clinic.
Work Schedule: Monday-Friday variable days/shifts intermittently
Job family (Series)
Help Requirements 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
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.
BSN and/or Master's degree from an accredited school of nursing recognized by the VA (Commission on Collegiate Nursing Education (CCNE) or The Accreditation Commission for Education in Nursing (ACEN).
Two years of successful nursing practice in acute / critical / MSU within the last 5 years
Lean Principles Training. (Belt).
Current proficiency in Basic Life Support (BLS) through the American Heart Association (Required prior to assuming clinical duties and must remain current -VHA Directive 11-77)
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.
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.
Use and function of all normal motor and sensory anatomy for provision of patient care, reading, writing, listening, observing/seeing, heavy lifting, bending, pulling, pushing, stooping, squatting, walking, standing, use of fine motor muscles; visual and auditory acuity; emotional intelligence to respond to stressful and/or emergent situations and crises appropriately and calmly; self-care skills to maintain physical, psychological, and emotional health. Examples include: heavy lifting of 45 pounds and over, heavy carrying of 45 pounds and over, straight pulling, pushing, reaching above shoulder, use of fingers, both hands required, walking, standing, kneeling, repeated bending, ability for rapid mental and muscular coordination simultaneously, near vision correctable at 13" to 16" to Jaeger 1-4, far vision correctable in one eye to 20/20 and to 20/40 in the other.
Financial Disclosure Report: Not 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.