Specialty Case Management RN

About the role

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.

What you will do

• 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

Requirements

• 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).

Education

***Continued from the Duties Section.

Clinical care - Monitors adherence to treatment plans, intervenes according to clinical guidelines, documents findings accurately and timely, and communicates necessary to the care team. - Completes hands-on clinical tasks within the nursing scope of practice (including but not limited to lab draws, medication administration, dressing changes, injections and testing) based on completed competency and patient need. - Provides care and case management primarily through in-person visits, with virtual platforms and telephone interactions used as supplemental tools when clinically appropriate and operationally feasible. - Serves as a resource for clinic Registered Nurses (RNs), Licensed Practical Nurses (LPN)s, Nursing Assistants (NAs) and Health technicians.

Education - Provides education and mentorship to healthcare staff, including case management processes, clinic workflows, VA systems, and onboarding support for new programs and coordinators.

Performance, policy & professional development - Participates in activities that support local and national performance goals. - Contributes to the development and implementation of policies and procedures related to case management and specialty care. - Maintains up-to-date knowledge and skills in case management and specialty clinical areas and applies them in practice. - Participates in clinical research or evidence-based practice initiatives related to case management or specialty care.

Collaboration & program improvement - Builds collaborative working relationships within the organization and community to enhance care for patients. - Serves as a resource for team members and identifies opportunities for program improvement at the local level.

Additional responsibilities - May include maintaining patient databases by reviewing consults and medical records to ensure ongoing care needs are met. - Coordinates and manages VISN-level referrals. - Facilitates surveillance and supports local, VISN, and national programs and teams.

Additional duties to be assigned based on specialty service, service volume, team members, National Directives/Mandates, etc. to meet the needs of the patient. Each Specialty Service is set up independently based on volume/size and interdisciplinary team members assigned within the service. The above scope is included within but not limited to each service.

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment.

You can verify your education here: *** If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education.

For further information, visit: ***

How you will be evaluated

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC.

WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

Your application, resume, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.

NOTE: Candidate's education, scope, and length of nursing practice (experience) will be considered in determining the grade and salary of the applicant selected. The recommended salary may be at any point in the range listed for this vacancy.

Experience as an RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following five dimensions of nursing: Practice, Veteran/Patient Driven Care, Leadership, Professional Development, and Evidence/Based Practice/Research.

Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social).

Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position.

It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.

Documents you must provide

• RN License SF-50/ Notification of Personnel Action The following documents are accepted and may be required if applicable to your eligibility and/or qualifications for this position.
• Cover Letter DD-214/ Statement of Service Disability Letter (Schedule A) Disability Letter (VA) License Long-form resume/Curriculum vitae (CV) RN License PCS Orders Performance Appraisal Professional Certification Separation Notice (RIF) SF-15 SF-50/ Notification of Personnel Action Transcript Veterans' Preference Note: Preference eligible candidates and other Veterans will be given preference when qualification of candidates are approximately equal for Title 38 positions in VHA.
• When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire.
• You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.).
• If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation.
• Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form.
• Documentation is required to award preference.
• For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.

What to expect next

Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met.

After the review is complete, a referral certificate(s) is issued, and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.

You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center. NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).

It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service.

HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities.

HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities.

HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.

Additional information

The William S. Middleton Memorial Veterans Hospital is committed to fostering and sustaining an environment which celebrates diversity, provides equitable opportunities for employment and promotion, and supports inclusiveness in our culture.

Together, we strive to create and maintain working and learning environments that promote professional growth and teamwork, and are inclusive, equitable and welcoming. We embrace our differences as individuals and unite as a team toward a common goal: to serve our nation's Veterans. 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 applicant's 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.