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Summary

The Patient Aligned Care Team (PACT) Nurse Care Manager (NCM) is a member of the PACT Teamlet (Primary Care Provider - Nurse Care Manager - Licensed Practical Nurse - Health Technician - and Clerical Associate) and supports the work of the expanded team (Pharmacist - Social Worker - Home Telehealth RN - Psychologist - and Dietician). This job opportunity announcement has a first cut-off 50 applicants. Once the first 50 applicants are received the announcement will automatically close.

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/12961494
• 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: See VA Directive and Handbook 5019 - Employee Occupational Health Service.

Duties

• - Demonstrates advanced clinical knowledge in assessing - planning - implementing - documenting - and evaluating care for an assigned panel of patients at Fayetteville Coastal Health Care System
• Recognizing the age-related cognitive - physical - emotional - and chronological maturation needs of the adult and geriatric patient focusing on chronic disease management
• - Identifies and provides case management for high-risk cohort of patients utilizing chronic disease management data mining tools to include but not limited to Care Management Tool (CMT) - Business Intelligent Strategic Learning (BISL) - VISN 6 Access Report - VISTA - and VHA Support Service Center (VSSC) reports such as PC Almanac - Compass - Primary Care Management Module (PCMM) Care Needs Assessment (CNA)
• - Utilizes other registries to manage disease processes such as Diabetic - Mammography - Cardiovascular - and Opioid Registries to access data base for pain management
• - Performs timely Post-Discharge/ ED/ Urgent Care - walk-ins - and schedule visits are addressed using appropriate documentation templates/notes - codes - education
• - Ensures Secure Messaging and telephone contacts are addressed timely
• - Assesses and enrolls eligible patients into nontraditional modalities of care such as Home telehealth and Telemedicine
• - Utilizes Teach and Motivational Interviewing techniques to encourage positive health behavioral change and Health Promotion and Disease Prevention
• - Provides patient and family education with a focus on self-management - prevention - and wellness - based on 'what matters most' to the patient
• Reviews - tracks - and devises strategies to improve Healthcare Effective Data Information Sets (HEDIS) metrics - clinical reminders - panel access - timely encounter closures - and other performance metrics
• - Facilitates continuity of care by partnering with multidisciplinary services - internal and external to the Department of Veterans Affairs
• - Initiates and participates in various quality and process improvement activities that result in improved patient outcomes
• - Enhances clinic access and team performance by pre-planning/ pre-appointment chart review huddles and weekly meetings with PACT team let and other members of the extended PACT
• Utilizes facility approved Nursing Protocols and Guidelines to enhance patient care as appropriate
• Collaborates with PACT and extended PACT to participate/provide shared medical appointments/group clinics for patients with specific chronic disease diagnosis
• - Demonstrates leadership by serving as an advocate for patients and a team leader with colleagues as he/she continues to enhance his/her own professional growth - continuing education and development
• - Completes any other nursing responsibilities as assigned by leadership
• 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: M-F 8:00AM-4:30PM