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    The incumbent will be assigned to Care in the Community (CITC) Section under the Office of the Chief of Staff, working in the CBOC in Sepulveda, CA.

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    The incumbent for this position will be assigned to the Care in the Community Section under the Office of the Chief of Staff and will work primarily at the Sepulveda Ambulatory Care Center, North Hills, California. The Clinical Care Coordinator is aligned within Care in the Community/VA Community Care and is responsible for providing the clinical leadership and expertise for the coordination of the medical center's non-VA care authorization program.
    Responsibilities include but are not limited to the Registered Nurse for the Clinical Care in the Community :

    • Responsible for patient care coordination in collaboration with the VA services and community care partners to co-manager Veterans' health.
    • Assist with program planning and implementation of a fully integrated Medical Center Care in The Community (CITC) Program
    • Formulate and document case management plan of care with measurable goals/objectives
    • Evaluate referral for various disciplines to develop care coordination plan
    • Communicate effectively both orally and in writing to monitor and manager patient care issues.
    • Demonstrate ability to utilize sound clinical judgment and knowledge of treatment modalities required
    • Identify and assure that VA and/or community resources match patient needs
    • Secure most appropriate level of care, access, and location for patient
    • Demonstrate ability to assess appropriate level of care to ensure compliance with National guidelines and provide access to care
    • Identify and intervenes for actual or potential crisis
    • Utilize community care forms, regulations, tools, templates, and SOPs to standardize documentation of care
    • Demonstrate collegiality and collaboration within the integrated teams, and across the VAMC
    • Knowledge and demonstrated leadership ability to identify and resolve issues relevant to patient care required.
    • Knowledge of Microsoft Office package and demonstrated ability to use the multiple programs within it such as: Word, Excel, spreadsheets preferred
    • Demonstrate knowledge of complex applications utilized for care coordination: CPRS, REF DOC, VISTA Capture Community Viewer, Joint Legacy Viewer, One Consult

    Work Schedule: Monday- Friday 8:00 a.m. to 4:30 p.m. schedule;
    Financial Disclosure Report: Not required

    Travel Required

    Occasional travel - You may be expected to travel for this position.

    Supervisory status


    Promotion Potential


  • Job family (Series)

    0610 Nurse

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/552967000. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.