This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appointment. Approval, award amount (up to $200,000) and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Learn more The RN is a self-directed professional who uses the nursing process and evidence-based practice to provide patient-driven, holistic care with the collaboration of the Teamlets (Patient, Primary Care Provider, RN CM, Clinical Associate) and larger Team (family/caregiver, internal and community-based services and disciplines involved in providing care to the patient). The RN utilizes health information and telecommunication to promote therapeutic relationships and shared decision-making between the patient and interdisciplinary team across the continuum of care to support patient self-management, prevention and wellness. She/he collaborates with the PACT Program in identifying patients for the Home Telehealth (HT) program. The CM/HT Nurse's responsibilities include but are not limited to: Using the nursing process and evidence-based practice to collaborate with the Core Team and Expanded Team in developing the patient-driven holistic care plan for life. Utilizing collaborative strategies and creative approaches in the delivery and improvement of holistic care for patients and family members. The RN functions as a member of the interdisciplinary team in the planning and management of care delivery to a complex patient population, supporting the transition and medical needs of patients in the outpatient setting, decreasing the need for hospitalization when possible. Provides specific in-home telehealth technology to an assigned group of patients with specific chronic conditions and mental health illnesses. Educates the patient/family on the technology to be used, as well as assessing, planning, implementing, documenting, evaluating and coordinating care based on the needs of the patient. Monitors patient status using home telehealth technology and other Telehealth modalities e.g. VVC. Transfers patient data into CPRS and other software packages as designated. Communicates timely with the provider and PACT RN when critical information is received. Functioning in a leadership role engaging staff in active problem solving regarding clinical and professional issues, leading to an improvement in care or practice. Providing patient and family health education with a focus on self-management, prevention and wellness based on the patient's goals. Demonstrating leadership by serving as an advocate for patients, as a team player to colleagues, to enhance his/her own and the team's professional growth, development and practice. Assisting with data collection, analyzing, trending, and reporting activities as they pertain to HT. Assisting with monitoring compliance with Conditions of Participation, Joint Commission and other regulatory agencies, standards and policies. Upholding the VA ICARE core values. Work Schedule: Monday-Friday, 8:00am-4:30pm Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.