Registered Nurse

Summary The Patient Care Team (PCT) Registered Nurse (RN) Care Manager is responsible for coordinating comprehensive patient care to ensure optimal outcomes for Veterans within the VA healthcare system. The RN Care Manager works collaboratively with interdisciplinary team members, including physicians, social workers, and ancillary staff, to facilitate patient-centered care and promote health, wellness, and disease management. Responsibilities Care Coordination: Coordinates care across the continuum, including primary, specialty, inpatient, and community services. Ensures seamless communication and collaboration among multidisciplinary team members. Comprehensive Patient Assessment: Conducts initial and ongoing assessments of patients' physical, psychosocial, and educational needs. Identifies Veterans at risk for deteriorating health or complex care requirements. Care Planning and Implementation: Develops individualized care plans based on assessment data, patient goals, and evidence-b...