Registered Nurse - Float IMC Primary Care

The Patient Aligned Care Team (PACT) Registered Nurse Care Manager (RNCM): Outpatient Primary Care (PC) is responsible and accountable for all elements of the nursing process when providing nursing care within the Primary Care PACT. The PACT RNCM assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction while functioning as a key team member providing comprehensive, coordinated nursing care to patients. This is a Float Position. PRINCIPALES MISSIONS : Major Duties: Serves as the primary care coordinator for a designated panel of patients within the Patient Aligned Care Team (PACT), providing comprehensive, patient-centered nursing care and care coordination. Accountable for all elements of the nursing process, emphasizing patient education, self-management, health promotion, chronic disease management, wellness, and customer satisfaction. Leads proactive, evidence-based nursing practice by applying clinical guidelines, nursing protocols, quality improvement principles, and population health strategies to improve patient outcomes. Coordinates and manages transitions of care across inpatient, outpatient, specialty, and community settings, ensuring timely access to appropriate healthcare resources and services. Provides care through multiple modalities, including face-to-face visits, virtual care, telephone encounters, and secure messaging. Uses population health tools, risk stratification, and panel management techniques to identify high-risk patients, close care gaps, prevent complications, and improve health outcomes. Delivers RN-led chronic disease management, preventive care, health coaching, motivational interviewing, and individualized care planning to support patient goals and self-management. Coordinates same-day care needs, post-discharge follow-up, referrals, laboratory and diagnostic testing, clinical reminders, procedures, and pre-visit planning. Collaborates with interdisciplinary team members, extended care support teams, patients, families, and community resources to develop and implement holistic, Veteran-centered care plans. Advocates for patients and families through education, support, and facilitation of services that promote continuity of care, wellness, and improved outcomes. Participates in daily huddles, pre-planning activities, and ongoing team communication to support access, continuity, quality, patient experience, and efficient clinic operations. Applies Whole Health principles and appropriate task delegation to strengthen team performance, care coordination, and achievement of PACT goals. Monitors performance metrics and utilizes VHA panel management tools to identify care gaps, support data-driven decision-making, and improve quality outcomes. Demonstrates leadership in professional nursing practice through evidence-based care, collaborative teamwork, resource management, and continuous quality improvement. Practices in accordance with applicable Nurse Practice Acts and licensure requirements governing professional nursing practice. VA offers a comprehensive total rewards package: VA Nurse Total Rewards 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, 7:30am-4:00pm Telework: Ad-Hoc Only. Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized QUALIFICATIONS REQUISES : Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C

Salaire : $85,610 – $173,974/Per Year | Avantages : http://www.vacareers.va.gov/why-choose-va/benefits/index.asp

OUR MISSION: To fulfill President Lincoln's promise "To care for those who have served in our nation's military and for their families, caregivers, and survivors" - by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate whole health care to Veterans? The South Texas Veterans Health Care System (STVHCS) is comprised of two inpatient campuses: the Audie L. Murphy Memorial VA Hospital in San Antonio and the Kerrville VA Hospital in Kerrville, Texas. The STVHCS serves one of the largest primary service areas in the nation, with 35 counties, and is part of the VA Heart of Texas Veterans Integrated Service Network (VISN 17), with offices located in Arlington, Texas. Providing a service to Veterans with a working staff of more than 4,300 employees, South Texas provides health care services for 114,000 Veterans. The STVHCS is a facility providing primary, secondary and tertiary health care in medicine, surgery