Specialty Case Management RN

The Specialty Case Management (CM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership experience and creative approaches in providing complex patient management. Provides patient management care coordination and discharge/disposition planning for inpatient and outpatient settings. The CM RN assists Veterans family members and caregivers with receiving the most appropriate options and services to meet their complex health care needs. This includes but is not limited to acute chronic multiple complex catastrophic or life-threatening illnesses; combat stress residuals of traumatic brain injury; community adjustment; addictions and other health problems. Coordinates care with multiple providers across all levels and sites of care. The CM RN addresses psychosocial as well as nursing and medical needs of patients and their families/caregivers through participation in
interdisciplinary patient care management practice. The CM RN also evaluates care and outcomes to ensure timely and appropriate provision of services. Collaborates in the development implementation evaluation and revision of policies procedures and/or guidelines. Demonstrates performance and leadership that is broad enough to improve the
care for a group of patients. Provides peers with formal or informal constructive feedback for improvement. Supports colleagues and other nurses through CM knowledge sharing to provide safe quality nursing care. Fosters a safe and supportive environment conducive to the professional development of health care professionals. Evaluates CM outcomes of evidence based decisions and practice changes for individuals groups and populations. Responsible for the documented CM 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.

Responsibilities include but are not limited to:
Operations & care coordination
- Supports patient care across the health care continuum including inpatient and
outpatient operations including patient flow appointment management triage patient
education monitoring progress toward care goals and ensuring timely follow-up.
- Participates in patient encounters as part of the interdisciplinary team to help establish
and support patient goals of care.
- Uses the nursing process to develop implement and evaluate individualized care plans
in collaboration with the interdisciplinary team.
- Collaborates closely with the interdisciplinary team to coordinate outpatient treatment
plans and support treatment planning decisions.
- Uses a team-based approach to triage and resolve patient care concerns.
- Operates within a dynamic clinical environment requiring consistent physical presence
to facilitate timely care coordination direct patient assessment and real-time team
collaboration. Must demonstrate adaptability and the ability to provide cross-coverage
across units or service lines in response to fluctuating patient volumes staffing needs or
organizational priorities.
- Maintains baseline clinic nurse competency to provide basic clinical coverage when
needed to meet operational needs - including patient check-in routine triage calls and
general patient education - during short-term absences of clinic-based RN staff
consistent with individual competency and scope of practice.
Provider & consult support
- Provides daily support to providers by coordinating care with community and VA
facilities ensuring necessary records test results and information are available for
timely consultations and treatment planning.
- Ensures consults are received reviewed and appropriately managed (including
scheduling completing e-consults or discontinuing as appropriate) and works with clinic
staff to expedite new patient consults when medically indicated.
Patient communication & access
- Communicates with patients about their health care options within the VA and
community following eligibility guidelines and national directives.
- Works with VA Medical Centers contracted partners and community facilities to
address barriers to accessing needed services.
Strives to provide a positive patient experience through navigation of the health care system to ensure care needs are met.

***Continued in the Education Section.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Work Schedule: Monday-Friday 0730-1600
Telework: Not Authorized
EDRP Authorized: Contact the EDRP Coordinator for questions/assistance. Learn more
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
Financial Disclosure Report: Not required

• 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.
• You may be required to serve a probationary period.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process.
• Must pass pre-employment physical examination.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).

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.)

• BSN or Higher preferred.
• 3-5 years nursing experience preferred.
• Case management experience preferred.
• Outpatient Nursing experience preferred.
• Clinic experience preferred.