Registered Nurse - PACT Care Manager

Veterans Health Administration • Aurora, CO

1d

About The Position

The Registered Nurse Care Manager provides proactive, patient-centered primary care coordination for the PACT. The nurse supports transitions of care and Veteran-centered nursing care, and delivers preventive and chronic disease management through face-to-face visits, virtual encounters, secure messaging, and telephone-based services. The role uses nursing knowledge, evidence-based guidelines, standardized nursing procedures and protocols, population-health tools, and clinical reminders to identify and manage high-risk and chronically ill patients.

Working as part of an interdisciplinary team, the nurse participates in huddles and proactive panel management, supports self-management and Veteran-centered goals, coordinates same-day needs and post-discharge transitions, and connects Veterans with appropriate services, specialty care, wraparound services, and team resources. The position collaborates with PACT core and extended care support teams to improve access, continuity, patient experience, and quality outcomes. It also supports efficient, patient-ready visits through preplanning, communication, care-gap identification, and patient-data preparation.

Requirements

• Proficiency in basic written and spoken English.
• Graduation from an appropriately accredited school of professional nursing, or qualifying equivalent nursing education as described in the announcement.
• Current, full, active, and unrestricted registered professional nurse licensure in a U.S. State, Territory, Commonwealth, or the District of Columbia; the announcement describes a Graduate Nurse Technician exception for eligible candidates pursuing licensure.
• Meet the education and experience criteria for the assigned Nurse grade and level; requirements vary by grade and include nursing degrees and, for some levels, professional or specialized nursing experience.
• U.S. citizenship, except where appointment of a non-citizen is permitted under VA policy.
• Pass required pre-employment drug screening, background/security investigation, physical evaluation/examination, and onboarding requirements.
• Participate in the seasonal influenza vaccination program.
• Meet physical requirements that include substantial standing, walking, bending, reaching, lifting, transferring or repositioning patients, and potentially handling weights over 50 pounds using required mechanical devices when appropriate.
• Have visual acuity, good hearing, distinctive speech, manual dexterity, and the ability to physically control or protect oneself from physically abusive patients.

Responsibilities

• Provide primary care coordination for the PACT, including transition-of-care support and Veteran-centered nursing care.
• Deliver preventive health services, chronic disease management, patient education, and health coaching through in-person, virtual, secure-message, and telephone modalities.
• Use population-health tools, clinical reminders, evidence-based guidelines, and date-driven risk indicators to identify and manage high-risk, chronically ill, and rising-risk patients.
• Participate in interdisciplinary team activities, daily huddles, proactive panel management, and focused prioritization of care-management referrals.
• Coordinate same-day needs and post-discharge transitions by completing procedures, labs, follow-up, pre-visit preparation, clinical reminders, and referrals.
• Connect Veterans with appropriate services, specialty care, wraparound services, and interdisciplinary team resources.
• Provide individualized care, motivational interviewing, health coaching, and ongoing management for patients with chronic and ambulatory care-sensitive conditions.
• Coordinate care transitions between acute and ambulatory settings for patients with chronic disease, population-health, post-discharge, or acute needs.
• Collaborate with PACT core team members and the extended care support team to support access, continuity, patient experience, quality outcomes, and efficient patient-ready visits.
• Apply Whole Health principles and appropriate task delegation to strengthen team functioning and meet PACT performance goals.
• Use team metrics and VHA panel-management tools to identify care gaps, prepare patient data, and support proactive primary care delivery.

Benefits

• Competitive salary, regular salary increases, and potential performance awards.
• 50 days of paid time off per year, comprising 26 days of annual leave, 13 days of sick leave, and 11 paid Federal holidays.
• Traditional federal pension with five-year vesting.
• Federal 401(k), with VA contributions of up to 5%.
• Federal health, vision, dental, term life, and long-term care insurance; many federal insurance programs can be carried into retirement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree