The incumbent is assigned to the VISN 7 Caregiver Support Program Centralized Eligibility and Appeals Team (CEAT), which provides a state-of-the art continuum of services, education and resources to caregivers of Veterans with complex needs. As a member of the VISN CEAT, the incumbent has the responsibility for expert knowledge of eligibility criteria for the Program of Comprehensive Assistance for Family Caregivers, operation of the program, and reporting requirements within the assigned VISN. The incumbent performs a wide range of services, collaborating with inter-professional Centralized Eligibility and Appeals Team (CEAT) members to make eligibility determinations, tier level determinations, discharges, and appeals for the PCAFC. Uses clinical judgment in the interpretation of trends and patterns; application of regulation, policy, guidelines; and the recommendation of program enhancements. The Nurse Practitioner (NP) uses clinical judgment in the interpretation of trends and patterns; application of regulation, policy, guidelines; and the recommendation of program enhancements. The role of the NP is significant to the success of a high-performing, high reliability CEAT, as the NP plays a crucial role in the facilitation of prescribed medication and treatment, care coordination, advocacy, and education. The NPS' training in assessment and monitoring, diagnosing, treating, health restoration, wellness promotion, illness prevention, and coping facilitation are crucial to the CEAT's case review. The NPS' knowledge of disease management, special diet plans and medical conditions, medication prescription and administration, self-care completion, and caregiver education helps ensure CEAT clinical determinations are accompanied by comprehensive, whole health care plan recommendations, for the Veteran's facility healthcare team to consider for safe and quality care continuity. Uses knowledge of the CSP to matrix Veteran level of functioning with the appropriate CSP services (i.e., Program of General Caregiver Support Services [PGCSSI; PCAFC; and/or Veteran entitlements and benefits) in order to ensure patient safety, recovery, and program stewardship. end organizing delivery of care to assure continuity of care and peer accountability for practice, including access to care and discharge planning. Applies advanced nursing clinical knowledge/ judgment to promote staff involvement in planning, decision making, and evaluating PCAFC eligibility. Evaluates, systematically, current practice and formulates outcomes for groups of patients and/or organizational processes within area of expertise. Works with interprofessional team members at Regional, VISN and facility levels to ensure PCAFC eligibility determinations PCAFC are delivered objectively with strong, consistent inter-rater reliability with documentation and communication of outcomes in a direct and coordinated manner. Coordinates with other Regional CEATs and VACO CSP to develop and implement strategies for PCAFC eligibility, tier level, discharge, and appeals process and performance improvement. Leads a team in review of application and appeals. Conducts comprehensive clinical review of patient records to identify the presence of Veteran need for assistance with personal care services and/or the presence of supervision or protection needs on a daily basis, Documents information utilized in clinical eligibility determination and eligibility assessment tools. Assists the VISN with MISSION Act implementation, as it relates to CSP and PCAFC expansion. Receives, reviews and dispositions PCAFC initial eligibility decisions; reassessments; and appeal decisions for clinical eligibly determinations, Anticipated process: Reviews packets with eligibility documents submitted, by facilities, to VISN within 45 days, Renders reassessment decisions to include: ongoing program eligibility, tier changes, and discharges. (Notifications of rendered decisions are communicated, by VISN, back to the CSC, et referring facility.) Adjudicates first-level appeals for alternate VISN CEATs and second-level appeals for one of the other three CEAT Regions. Executes position responsibilities that demonstrates leadership, experience, and creative approaches to management of complex patient care. Maintains full clinical privileges as a member of the Medical Staff. Work Schedule: Monday - Friday, 8:00AM-4:30PM EST Financial Discloser 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.