Registered Nurse Patient Aligned Care Team Care Manager
Job Location:
Quincy, WA - USA
Yearly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
The Patient Aligned Care Team (PACT) Registered Nurse (RN) Care Manager will utilize the nursing process and evidence based practice to deliver and manage comprehensive care to an assigned panel of patients in a clinic setting. The RN is a key member of the PACT and multidisciplinary team and is responsible for collaboration with other team members promoting effective communication and ethical practice.
The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care you will operate in a model with three core elements seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veterans community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor Americas Veterans by providing exceptional health care that improves their health and well-being.
The primary duties for the PACT RN Care Manager position include but are not limited to the following:
- Coordinate comprehensive nursing care for a designated panel of patients within the PACT focusing on patient education chronic disease management self-management support and prevention services across in-person and virtual modalities.
- Utilize population health tools and evidence-based guidelines to identify high-risk and chronically ill patients; engage in structured panel management to optimize health outcomes and support ongoing patient self-management.
- Serve as the primary point of contact for Veterans and families providing proactive care management care coordination and ensuring timely access and transitions between primary specialty and extended care services.
- Conduct daily team huddles with PACT members to identify patients requiring RN care; deliver individualized interventions including health coaching motivational interviewing and ongoing management for chronic and ambulatory care-sensitive conditions.
- Apply clinical reminders standing orders and nurse protocols to deliver preventive health services chronic disease management and health coaching to achieve Veteran-centered care goals and improve outcomes within the practice setting.
- Coordinate same-day needs and post-discharge transitions by managing lab results procedures follow-ups and referrals ensuring Veterans are connected with appropriate internal and external resources.
- Identify care gaps using data-driven risk indicators and collaborate with interdisciplinary team members to prioritize and coordinate referrals for enhanced care management focusing on high-risk and rising-risk patient populations.
- Promote patient-centered care and wellness by advocating for patient needs facilitating Whole Health principles and supporting patients and families in achieving optimal health outcomes.
- Monitor and report team metrics using VHA panel management tools preparing patient data and supporting proactive high-quality care planning and delivery to meet PACT goals in access continuity and quality.
- Demonstrate leadership in professional nursing practice integrating evidence-based guidelines participating in quality improvement initiatives and ensuring compliance with the Nurse Practice Act and VA policies for safe effective patient care.
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 through Friday 0730-1600
Telework: Not Available
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.
- 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: You will be asked to participate in a pre-employment examination or evaluation as part of the pre-employment process for this position. Questions about physical demands or environmental factors may be addressed at the time of evaluation or examination.
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:
Manager
