Community Care Coordinator Nurse
Job Summary
Primary Purpose: Delivers fundamental knowledge-based care to assigned clients while developing technical skills. Assesses plans implements and evaluates the effectiveness of the Veterans care. Service to support delivery of high quality timely care to the Veteran receiving services in the community. Assumes the responsibility for the coordination of care focused on patient education self-management and customer satisfaction throughout the continuum of care.
Major duties include but are not limited to:
- Responsible for executing a streamlined approach to receiving triaging and directing timely coordinated care.
- Brings principles and theory with limited application of critical thinking skills.
- Possesses intimate knowledge of the internal referral care process clinical review criteria utilization management standards clinical documentation requirements community care regulations and Veterans Health Administration (VHA) standards and guidelines.
- Uses nursing knowledge and systems theory to assess organize facilitate and guide Veterans through their full range of care options including internal/direct care in Veterans Affairs and care in the community.
- Serves as a liaison to both internal and community providers and is responsible for managing the care of the Veteran throughout the consult process.
- Supports the medical centers mission to improve timely access to care ensure Veterans who want to receive care in the community are referred and scheduled into the community and support the delivery of high quality timely care to the Veteran receiving community services.
The ideal candidate possesses at least one year experience performing the following functions:
- Leading an integrated care team through providing clinical leadership and expertise on program processes and regulations.
- Demonstrating effective communication skills to collaborate and co-manage the patients care with the multidisciplinary team in a cost-effective manner.
- Serving as lead care coordinator for the patient and following the standardized care coordination model incorporating case management principles as applicable.
- Facilitating care unique to the patients needs monitoring tracking and intervening if necessary in the episode of care across the continuum.
- Performing clinical review of referrals for specialty care to include identifying pertinent medical records and diagnostic results to include with referral.
- Applying knowledge related to policy guidelines utilization review criteria and current evidence based standards of care.
- Reviewing requests for continued care or higher level of care and composing clinical summary of requests to facilitate provider clinical review.
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: Full Time 0800 - 1630
Telework: Ad-Hoc
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
- 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.
- 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 drivers 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 evaluation/examination.
- Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
- You may be required to serve a probationary period.
- Complete all application requirements detailed in the Required Documents section of this announcement.
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 masters level bridge program in nursing who have completed coursework equivalent to a bachelors 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.)
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: I Level I
Reference: For more information on this qualification standard please visit Requirements: See VA Directive and Handbook 5019 Employee Occupational Health Service.
This job opportunity announcement may be used to fill additional vacancies.
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.
If you are unable to apply online or need an alternate method to submit documents please reach out to the Agency Contact listed in this Job Opportunity Announcement.
Under the Fair Chance to Compete Act the Department of Veterans Affairs prohibits requesting an applicants criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process visit Human Resources and Administration/Operations Security and Preparedness (HRA/OSP) at The Fair Chance Act.
Candidates should be committed to improving the efficiency of the Federal government passionate about the ideals of our American republic and committed to upholding the rule of law and the United States Constitution.
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. Opens in a new windowLearn more about federal 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.
Required Experience:
IC