The incumbent practices as an RN on the Referral Coordination Team (RCT) at the Sheridan VA Health Care System. The RN will review patient community care eligibility and medical necessity of services requested. Incumbent works in a multidisciplinary team to coordinate specialty care referrals within the VA Healthcare System. Specific duties include, but are not limited to: - Communicates with Veterans on their health care options including local VA, other VA Medical Centers and community based eligibility. - Works closely with other VA Medical Centers, contracted facilities and community facilities to remove obstacles that would impede the Veteran from utilizing the services of other VA medical centers. - Outpatient specialty clinic care coordination and patient flow management, including appointment management. - Collaborates with clinic staff to ensure patients are given timely appointments and expedite new patient consults. - Reviews internal and/or community care referrals for medical necessity of requested services using clinical judgement and refers cases to specialty care. DOAs or RCF LIP as appropriate. - Educate providers on medical management processes. - Redirection of SVAHCS enrollees into VHA network. - Triages and applies a collaborative team approach in identifying, analyzing, optimizing utilization of VHA/SVHACS resources. - Collaborates referral services and consultant services to develop care coordination agreements (service agreements). - Educates staff on care modality options to include tele-health or e-consults. - Data mining to include, but not limited to, referrals patterns including discontinuation or cancellations patterns. - Provide clinical knowledge and act as a clinical resource to non-clinical multidisciplinary staff. Work Schedule: 7:30am-4:00pm Monday through Friday Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.