Registered Nurse-Heart Failure Case Manager

Full Job Description

The Orlando VA Medical Center is seeking a Heart Failure (HF) Case Manager Registered Nurse (RN) to provide comprehensive care for Veterans with Heart Failure across the Outpatient clinic.

The HF RN Case Manager systematically assesses the health status of Veterans, documents related health data in accordance with institutional policy, and identifies risk factors to reduce readmissions while optimizing the course of treatment for complex cardiovascular patients.

Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C.

7403(f), 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 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); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program.

Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program.

(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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program.

Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).

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.

Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade.

The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12917410.

Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.

An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.

Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.

An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.

Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations.

An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience.

Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.

A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience.

Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.

MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

*Note: Foreign education programs/degrees are not creditable as related degrees.

Preferred Experience: Previous Case Manager experience Previous Cardiology experience Cardiology Clinical experience Preferred MSN Experience in program development Experience in data collection Highly preferred Case Manager Certification or other VA approved certification Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: This position requires moderate lifting, heavy carrying, straight pulling, pushing, reaching above shoulder, use of fingers, both hands required, walking, standing, kneeling, repeated bending, climbing - legs only, Near vision correctable, far vision, ability to distinguished basic colors, ability to distinguish shades of colors, hearing and emotional stability.

Major Duties:

The Heart Failure (HF) Case Manager Registered Nurse reports to the Nurse Manager, Cardiology, and provides comprehensive, patient-centered care for Veterans with heart failure across outpatient settings, with transitional oversight in inpatient and emergency areas as needed.

The primary focus of this role is to contribute to the reduction of heart failure hospitalizations by systematically assessing clinical status, identifying risk factors, and documenting all findings in accordance with policy to optimize treatment for complex cardiovascular patients.

Other duties included but not limited to are: Manages HF consults; develops and coordinates individualized care plans; and provides targeted education to Veterans, families, and caregivers on HF management, lifestyle modification, self-management skills, and available resources.

Screens for social determinants of health and collaborates closely with interdisciplinary teams, including cardiology, primary care, pharmacy, nutrition, and social work, to ensure continuity, standardization, and optimal care outcomes.

Key responsibilities include leading patient education classes and support groups, participating in Care Coordination Review Team meetings, serving as lead coordinator for assigned Veterans, and monitoring clinical status using evidence-based HF protocols and national guidelines.

Facilitates referrals.

Serves as a liaison with community providers Supports quality improvement, data collection, evidence-based practice initiatives, and HF program development, oversight, and dissemination across the VA system.

Manages program logistics, educational materials, and team communications, as well as mentoring staff and students.

Functions independently, acts as a change agent, fosters teamwork and innovation, and promotes patient engagement to improve health outcomes and reduce avoidable HF readmissions.

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, 8:00am-4:30pm, with flexibility for occasional weekend or program-related activities.

Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized