Registered Nurse

1 month ago

San Diego, California, United States Veterans Health Administration Full time

The Home Based Primary Care (HBPC) RN Case Manager provides nursing assessment, care coordination, skilled nursing care, and chronic disease management in the homes of Veterans including private residences, residential care facilities, assisted living facilities in collaboration with the HBPC interdisciplinary team.

HBPC nursing practice is focused on longitudinal and comprehensive primary care, rehabilitation, disease management, caregiver assistance, and integrative case management to support the Veteran's goal to safely remain in the home.

The HBPC RN assumes the following major duties and responsibilities:

  • Develops and manages the individualized patient plan of care to include ongoing assessment, care planning, care coordination, monitoring, and evaluating clinical outcomes.
  • Provides health teaching, health counseling, provision of care supportive to restorative to life and well-being.
  • Provides skilled primary care nursing interventions in the home such as vaccinations, urinary catheter changes/maintenance, and venipuncture/specimen collection.
  • Provides nursing medication management, education, and monitoring.
  • Documents patient care assessments, interventions, care coordination, quarterly reviews, and care plan outcomes in the electronic medical record.
  • Provides nursing care coordination to ensure comprehensive service delivery including referral to resources/clinical services within the VA San Diego Healthcare System and/or community agencies.
  • Plans, schedules, and completes nursing visits in the home, clinic, by phone, or using approved video technologies.
  • Provides comprehensive nursing case management through communication with the HBPC Interdisciplinary team, specialty clinics/services, inpatient acute care, transportation services, community home care agencies, community hospital/providers, Caregivers, skilled nursing facilities and RCFE staff.
  • Maintains a panel of Veterans requiring ongoing chronic disease management and nursing interventions.
  • Provides leadership in unit performance improvement, shared governance, HRO, and system redesign initiatives.
  • Maintains a valid and unrestricted driver's license for travel to Veteran homes and various VASDHS locations during both day and night time tour of duty hours.
  • Follows policies for care and maintenance of assigned government vehicles.
  • Serves as a preceptor and/or clinical resource for nursing and HBPC interdisciplinary team.
  • Develops/Updates unit-based policies and standard operating procedures.
  • Participates on local, VISN, and/or national HBPC committees, councils, or workgroups.
  • Performs other duties as assigned.
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:
Full Time; , 10 hour compressed tour

Driving Requirement:
Yes

Telework:
N/A

Virtual:
This is not a virtual position. This position will be based at the Oceanside Clinic.

Relocation/Recruitment Incentives:
Not Authorized

Financial Disclosure Report:
Not required

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