Registered Nurse - Remote Patient Monitoring - Home Telehealth Care Coordinator
Summary
VA Greater Los Angeles Healthcare (VAGLAHS) is seeking (2) highly skilled and experienced RN's for the Remote Patient Monitoring Home Telehealth position. Responsible for all elements of the nursing process, care coordination, patient education, and health promotion. Collaborates with the interdisciplinary team and demonstrates leadership in managing complex care. Duties Help Duties include, but are not limited to:
- Serves as the Remote Patient Monitoring - Home Telehealth (RPM-HT) RN Care Coordinator, utilizing clinical expertise and leadership in the management of high-risk, complex patients via telehealth technologies.
- Coordinates care delivery through Remote Patient Monitoring (RPM) under the Home Telehealth (HT) program to support Veterans in non-institutional, Remotica-effective settings.
- Applies principles of Care Management and Case Management to promote care continuity, access, and efficiency.
- Utilizes Clinical Information Systems (CIS), Telehealth Management Platform (TMP), and data analytics to guide interventions and monitor outcomes.
- Performs comprehensive HT clinical assessments, including health history, review of systems (ROS), and psychosocial evaluation to develop individualized Care Coordination Plans (CCPs).
- Triages and evaluates biometric and subjective data transmitted via HT devices (e.g., BP, weight, SpO2, glucose, symptom surveys).
- Detects early signs of disease exacerbation and facilitates timely interventions with PACT, ED/UCC, Specialty Clinics, or Community Care (CCN).
- Engages in collaborative care planning with interdisciplinary teams such as HBPC, MH, SW, Nutrition, Pharmacy, and Rehab Services.
- Assesses patient knowledge, health behaviors, self-efficacy, and readiness to change to support Chronic Disease Self-Management (CDSM).
- Provides Veteran-centric health coaching, motivational interviewing (MI), and disease-specific education to improve adherence and outcomes.
- Communicates patterns, trends, and clinical concerns with IDT, escalating to LIP when warranted.
- Implements evidence-based protocols to reduce hospitalizations, ED utilization, and avoidable acute care episodes.
- Evaluates and documents clinical and programmatic outcomes aligned with HT performance metrics and SAIL measures.
- Supports Telehealth Clinical Technician (TCT) staff and fosters a safe learning environment for professional development.
- Leads or participates in quality improvement (QI) initiatives to enhance telehealth care delivery at the service, VISN, or national level. 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 Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Requirements Help Conditions of employment
- U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
- All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
- Selective Service Registration is required for males born after 12/31/1959.
- Subject to background/security investigation.
- Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements ( Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
- Must pass pre-employment physical examination.
- Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
- You may be required to serve a probationary period.
- Complete all application requirements detailed in the "Required Documents" section of this announcement.
Qualifications
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 accredi
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