Registered Nurse - Patient Aligned Care Team

Duties include but are not limited to: Ongoing, continuous care of one or more assigned panel(s) of Veterans Manage the care of patients through direct and indirect care, while organizing and prioritizing patient care needs, and ensuring assigned tasks are completed. Administering medications, immunizations and nursing procedures per established policies and guidelines. Utilizes all available tools, such as registries, to enable effective and efficient identification and intervention of individual patients and cohorts Participates in team performance improvement and sustainment activities to optimize team efficiency and care delivery of patients Manages communications and facilitates safe transitions of patients between the PACTs site of care and other health care settings, using informal and formal communication methods, as appropriate Provides health education and health coaching on wellness, disease prevention, chronic care management, and self-management skills to patients and pers