The Community Care Clinical Coordinator is a registered professional nurse, qualified by education and experience utilizing evidence-based practice to support the Community Care Program in planning, designing, integrating, implementing, modifying, and evaluating the effectiveness of program components and/or services regarding quality, appropriateness, and timeliness of care for VA and Community Care Coordination. Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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. 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. Preferred Experience: - 2-3 years' experience in clinical nursing - Case Management experience preferred Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade: Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: This position involves considerable amount of standing, walking, stooping, bending, reaching, lifting, and turning. It requires restraining confused clients, repositioning patients, assisting with transfers from wheel chairs/stretchers and transporting them to other departments or facilities. Mechanical devices are available and are required to be used for heavy or difficult to lift clients. The work may involve pushing or lifting in excess of 50 pounds and going up and down flights of stairs. The position requires visual and auditory acuity at a level to provide safe and effective nursing care. The position requires the nurse to work for periods of time with arms above shoulder level or with neck in a fully flexed or extended position and the ability to physically control or defend against emotionally ill clients. The position also requires ability to work on computers for extended periods of time. ["Accountable for the delivery of quality, age-specific healthcare; for utilizing critical thinking skills and sound clinical judgement to ensure positive patient outcomes; for demonstrating ethical practice; and for participating in performance improvement activities to improve the quality of care and ensure performance measures are met and/or exceeded. They are accountable for adhering to established policies, standards of care, and standards of practice. The incumbent assesses, plans, implements, supervises, teaches, evaluates, and documents patient care; serves as an integral member of the treatment team, and is responsible for helping to produce a therapeutic environment and plan of care to promote optimal health status. The incumbent supports the Medical Center's mission and values through utilization of Relationship Based Care to support Indy Excellence VA offers a comprehensive total rewards package: VA Nurse Total Rewards Duties included but are not limited to: Utilizes comprehensive knowledge of advanced clinical practice and case management principles to assess appropriate level of care and to ensure compliance with established Community Care authorities and guidelines resulting in approvals and/or denials for Community Care Reviews medical referrals/appointments and general hospital procedures by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology, and pharmacy. Performs review for planned inpatient and outpatient surgery; and performs concurrent review to include length of stay (LOS) for the facility's inpatients using appropriate criteria. Acts as referral approval authority for designated referrals per Community Care guidance and standards. Ensures and monitors specialty care referrals for appropriateness, medical necessity, and if the appointment, diagnostic testing, or procedure requested is a covered benefit according to Community Care eligibility. Receives and makes patient telephone calls, written, or e-mail correspondence regarding specialty clinic appointments and referrals. Responsible for performing prior authorization review of services that require notification, using applicable benefit package and specific recognized clinical guidelines and criteria. Interacts with providers to obtain clinical information to support prior authorization determinations and provide support for their questions. Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Work in collaboration with co-workers to ensure timely and efficient completion of all workflows within the Department. Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday-Friday, 8:00 am - 4:30 pm Telework: May be Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Financial Disclosure Report: Not required"]
About Veterans Affairs, Veterans Health Administration
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.