Transfer Coordinator Registered Nurse

The Transfer Coordinator RN is built on a Veteran and family-centered approach, and delivered by an interdisciplinary team which exists both within and outside the VA San Diego Healthcare System (VASDHS). Transfers are provided to eligible Veterans and coordinated by an RN specializing in care coordination. The Transfer Coordinator RN facilitates the flow of Veterans between VASDHS and non-VA community facilities by serving as a point of contact for transfers.

Major duties

The Transfer Coordinator RN assumes the following major duties and responsibilities: Coordinates obtaining and reviewing applicable medical records and associated documentation to Physicians. Facilitates contact and communication between transferring and receiving physicians and pertinent staff responsible within VA and outside facilities. Provides timely updates of information and places required documentation in the Electronic Health record. Utilizes the Bed Management System (BMS) to identify bed availability and documenting/updating inter-facility transfer requests, including monitoring timely Veteran access. Assisting with facilitation of physician/clinical consultations, as needed, to render timely clinical decisions to expedite care. Utilizes CPRS to document details regarding transfer requests, decisions made, and recommendation including consultation with community care staff and community hospitals, referencing Community Care guidelines as applicable. Works with the Nursing & Patient Care Services leadership in the flow of patients from VASDHS to other-VA medical facilities and non-VA care facilities when necessary. Conducts utilization review to identify medical necessity, intensity of service and transitions to different clinical settings for VASDHS. Works with other-VA and non-VA care Nurse Case Managers, Transfer Coordinators, physicians, and administrators seeking services from VASDHS. Utilizes lnterQual criteria to identify medical necessity and intensity of service for transfer referrals. Documents outcomes of utilization management in their respective assigned areas where resource utilization is impacted, and clinical decisions are made that have potential to alter the course of patient care and VASDHS. Determines level of care and refers requests to appropriate Services/Case Managers for transfer consideration. Discusses Veteran transfer concerns with an interdisciplinary team (physicians, social workers, case managers, pharmacists, and nutritionist). Act as patient and family advocate and assesses clinical outcomes. Coordinates the modes of transportation used in the transfer process i.e. ambulance, critical air, and secure transport. Act as a liaison, providing a bridge between caregivers within and outside the VASDHS for emerging medical, psychosocial, or rehabilitation problems, managing the continuum of care and care coordination. Demonstrates compliance with Code of Conduct and compliance policies and acts to resolve compliance questions or concerns and reports suspected violations. Participates in unit-based in-services, and mandatory education activities in a self-directed manor. Performs other duties as assigned.

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: Full time; M-F 8-hour shifts. May include holidays and weekends
• Telework: not available
• Virtual: This is not a virtual position.
• Relocation/Recruitment Incentives: not authorized

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 accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/13081386.

Grade/Level Scope Education

• Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies. An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.
• Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex. An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.
• Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience.
• Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience.
• Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting. MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

*Note: Foreign education programs/degrees are not creditable as related degrees.

Preferred Experiences:

• Education: Required BSN, preferred MSN, or Master's in Healthcare Related Field.
• Minimum recent 3 years acute clinical care experience;
• Preferred case management certification.
• BLS certification required.
• Strong knowledge of relevant healthcare and clinical operations including information technology (preparing reports, MS Office Suite and computer knowledge), patient care workflows and processes.
• Demonstrate organizational and project management skills, with the ability to lead a team, prioritize tasks, and see projects through from inception to completion.
• Strong analytical and critical thinking skills, with the ability to quickly analyze problems, determine appropriate level of intervention, and develop and apply effective solutions.
• Strong interpersonal skills for effective information exchange and problem solving with all levels of management and staff, consultants, and outside agencies.
• Flexibility and ability to work in a rapidly changing environment.
• Self-starter with good time-management skills.
• Flexibility and ability to work in a rapidly changing environment.
• Self-starter with good time-management skills.

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: This position requires potentially long periods of continued sitting, walking to and from meetings and some traveling to and from community providers/hospitals and community-based outpatient clinics (CBOCs). The incumbent must be able to climb stairs as well as mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs and workload.

Education

Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program.

Requirements

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 (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). 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. As a condition of employment for accepting this position, if needed, you will be required to serve a 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.