Registered Nurse, Telehealth Care Coordinator

Veterans Health Administration • Phoenix, AZ

5d

About The Position

The Registered Nurse, Telehealth Care Coordinator is responsible and accountable for all elements of the nursing process when providing or supervising direct patient care. The nurse assesses, plans, implements, and evaluates care using age-specific components and coordinates care focused on patient education, self-management, and customer satisfaction throughout the continuum of care.

The Remote Patient Monitoring (RPM) Home Telehealth (HT) Registered Nurse Care Coordinator uses leadership, experience, and creative approaches to manage complex patient care. Home Telehealth applies care and case-management principles, health informatics, disease management, and telehealth technologies to coordinate access to appropriate care and improve Veterans’ health. The program seeks to improve clinical outcomes and access to care while reducing complications, hospitalizations, and clinic or emergency-room visits among Veterans in post-acute care settings and high-risk patients with chronic or mental health conditions.

The HT RN performs comprehensive initial and ongoing assessments, including review of systems, and develops plans of care. The nurse triages and assesses patient-submitted data, including vital signs, reported symptoms, and questionnaire responses, and intervenes when complications may be developing. Care is coordinated with Patient Aligned Care Team clinics, emergency departments, urgent care, community providers, and interdisciplinary programs and services. The nurse also supports patient self-management through health coaching, education, and motivational counseling, and communicates relevant progress, trends, concerns, and intervention needs to the interdisciplinary team.

The position contributes to a safe and supportive professional environment through constructive feedback, knowledge sharing, collaboration, professional development, and evidence-based nursing practice. The work schedule is 07:00–15:30. Telework may be available ad hoc at the supervisor’s discretion; this is not a virtual position. Relocation and recruitment incentives and Permanent Change of Station authorization are not available.

Requirements

• Be proficient in basic written and spoken English.
• Graduate from an appropriately accredited school of professional nursing, subject to the stated provisions for qualifying bridge-program candidates and foreign nursing education.
• Hold current, full, active, and unrestricted professional nurse registration in a U.S. state, territory, commonwealth, or the District of Columbia; the posting also describes a Graduate Nurse Technician exception for eligible candidates pursuing licensure.
• Meet the education and experience qualifications for the applicable VA nurse grade and level.
• Meet the applicable grade-level scope, education, and dimension criteria, including practice, Veteran/patient-driven care, leadership, professional development, and evidence-based practice/research.
• Meet U.S. citizenship requirements, except where VA policy permits appointment of non-citizens when qualified citizens cannot be recruited.
• Complete required pre-employment screening and onboarding, including a drug test if tentatively selected for a testing-designated position, background/security investigation, and physical evaluation/examination.
• Comply with the seasonal influenza vaccination program requirement for VA health care personnel.
• Meet Selective Service registration requirements if applicable.
• Be able to perform the position’s physical duties, which may include walking, bending, stooping, some lifting, extended sitting or standing, and transferring patients or objects using safe patient-handling protocols and provided mechanical lifts.

Nice To Haves

• Direct experience with Remote Patient Monitoring or Home Telehealth care coordination.
• Strong knowledge of remote patient assessment.
• Demonstrated ability in health care coaching, patient education, and motivational counseling in a virtual care setting.

Responsibilities

• Provide and supervise direct patient care, applying the nursing process to assess, plan, implement, and evaluate care.
• Coordinate care focused on patient education, self-management, and customer satisfaction throughout the continuum of care.
• Perform initial and ongoing comprehensive patient assessments, including a review of systems, and establish a plan of care.
• Triage and assess Home Telehealth patient data, including vital signs, reported symptoms, and questionnaire responses.
• Identify potential complications or exacerbations and facilitate timely care through PACT clinics, emergency departments, urgent care, or community care.
• Exchange information and coordinate with community-based providers for co-managed care.
• Consult and coordinate interventions with interdisciplinary services, including Home Based Primary Care, mental health, social work, pharmacy, and nutrition.
• Identify patients’ knowledge, health factors, skills, and behaviors that support self-management, as well as gaps in those areas.
• Provide health care coaching, patient education, and motivational counseling.
• Communicate patient progress, goal attainment, data or symptom trends, concerning findings, and needs for provider assessment or intervention to the interdisciplinary team.
• Provide peers with constructive feedback and support a safe, supportive environment for healthcare professionals’ development.
• Contribute a professional nursing perspective to interdisciplinary discussions and collaborate to achieve optimal outcomes.
• Share knowledge, educational findings, experiences, and ideas with peers to support safe, quality nursing care.
• Question clinical practices and participate in activities that sustain evidence-based practice.

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, and federal 401(k) with up to 5% in contributions by VA.
• 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