Registered Nurse (Patient Aligned Care Team)

Quick Facts

• Role: Outpatient Registered Nurse (Patient Aligned Care Team)

• Setting: Primary Care Clinic using the Patient Aligned Care Team model

Description

Provide day-to-day case management and organize team members to achieve desirable patient outcomes in an outpatient, primary care environment. Assess, triage, plan, implement, document, and evaluate care for a designated group of patients across the care continuum. Collaborate with patients and an interdisciplinary team to coordinate physical, psychosocial, and environmental needs and resources.

Responsibilities

• Demonstrate clinical knowledge in assessing, planning, implementing, documenting, and evaluating patient care.

• Triage and apply a collaborative team approach to identify, analyze, and resolve patient care problems.

• Collaborate with patients to assess needs, set care goals, and identify resources for discharge, post-hospital recovery, and health maintenance.

• Maintain knowledge of multidisciplinary resources and refer patients to community resources as appropriate.

• Use problem-solving methodologies to address system and process impacts on patient care.

• Assist patients in navigating health systems; intervene or refer as needed to achieve outcomes.

• Provide care that respects patients’ personal values, cultural beliefs, and preferences.

• Develop, assess, and monitor comprehensive care plans to ensure coordinated wellness-oriented care.

• Coordinate an interdisciplinary approach to deliver resources addressing physical, psycho-social, and environmental needs.

Benefits

• Competitive salary with regular salary increases and potential performance awards

• Paid time off: 50 days/year (26 annual leave, 13 sick leave, 11 paid federal holidays)

• Retirement: federal pension (5 years vesting) and federal 401(k) with up to 5% employer contributions

• Insurance: federal health/vision/dental/term life/long-term care options

• Licensure: one full and unrestricted RN license from any U.S. state or territory

• Work schedule: to be determined as openings become available

• Compressed/flexible schedule: authorized

• Relocation/recruitment incentives: not authorized

• Education Debt Reduction Program (EDRP): approved / authorized