Registered Nurse- Facility Care Coordination and Integrated Case Management Coordinator

Department of Veterans Affairs

The Facility Care Coordination and Integrated Case Management (CCICM) Coordinator Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients. Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.

• Major duties include, but are not limited to: The CCICM Coordinator is administratively responsible, in collaboration with the CCICM Social Worker (SW), for the clinical programming and daily operations of the CCICM throughout the facility. Develops and implements policies and procedures to ensure compliance with the local facility, Veterans Integrated Systems Network {VISN), Office of Nursing Services {ONS), and Veterans Affairs Central Office (VACO) directives and handbooks. Develops and implements a facility level framework for implementation of national standardized processes and tools that integrate communication, collaboration, and coordination across services and programs to expand upon existing Veterans Health Administration {VHA) program approaches and address concerns about care coordination service delivery gaps and service duplication. Participates in the development of policies, procedures, and practice guidelines for the program and participates in facility, VISN, and national program development as related to CCICM. Provides guidance and support in the implementation and maintenance of the program through education, training, mentorship, and coaching. Develops, implements, and tracks facility wide CCICM education plan to key stakeholders. Ensures full collaboration with social work counterpart, for all planning, development, implementation, monitoring, and evaluation of the CCICM operations. Manages, monitors, evaluates, and reports on all CCICM related data to fully capture the day-to-day functioning and practice impacts on the facility and Veteran care. Identifies Veteran cohorts across the facility with the highest opportunity and highest need; including development and implementation of a monitoring process for ongoing screening and identified cohort(s). Actively participates in the treatment planning process with other disciplines, including involvement in discharge planning with other disciplines and will be responsible for ensuring that discharge plans are executed in a manner that are timely and appropriate. Ability to develop needed community support and/or resources to ensure the program goals are achieved. Provides direct patient care services to identified high utilizer/at-risk Veterans to ensure appropriate services are in place to support the CCICM framework. 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: ADHOC-May be authorized (Employee who Telework on an occasional, episodic, or short-term, and have completed required telework training and telework agreement). Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being.

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