The Registered Nurse discharge planner is responsible for coordinating the discharge process for patients leaving the hospital. Discharge Planners must facilitate the safe and timely discharge of patients by assessing their individual needs, developing comprehensive discharge plans, coordinating follow-up care and services, and ensuring a smooth transition back to their home or community setting.
Major duties and responsibilities: Completes an admission assessment including anticipated needs for continuity of care and discharge planning and documenting this information in the electronic health record. Collaborates with the interdisciplinary team to ensure a comprehensive and holistic approach to care for veterans. Facilitation and tracking of attendance during interdisciplinary rounds.
Provide support and guidance to veterans and their families throughout the discharge process. Evaluate veteran and family response to guidance and provide reinforcement as necessary. Document all instructions given and an evaluation of the response in the electronic health record.
Completes the nursing review of the Geriatric Extended Care referral to skilled nursing and other VA continuing care programs, indicating the anticipated post- hospitalization nursing needs of the Veteran. Collaborates in the development of discharge/home care plans based on needs identified and resources available. Performs home care needs assessment on high-risk Veterans returning home.
Coordinates discharge plans and referrals to home health care or hospice services with Veteran, significant others, facility staff and community agencies. Advocates for veterans to receive necessary resources and services post discharge. Ensures seamless communication between the veteran, healthcare providers, and community resources for a successful transition out of the hospital. Utilizes InterQual criteria to review appropriateness of level of care and recommendations.
Adheres to VHA Directives and local policies for discharge planning. Strong interpersonal skills for effective information exchange and problem solving with all levels of management and staff, consultants and outside agencies. Strong analytical and critical thinking skills, with the ability to quickly analyze problems, determine appropriate level of intervention, and develop and apply effective solutions. 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 Tour Information: Monday-Friday 8 hour shifts with flexibility to weekends Telework: Not available Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not authorized.
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.
Geehan.Chua@va.gov · (925) 372-2334
This position is with Veterans Health Administration, Department of Veterans Affairs.
The posted pay range is $103980 – $188494/yr.
This position requires a Other security clearance.
Applications close on 2026-10-05.
This position is open under the 'Public' hiring path.
Source: USAJOBS.gov — U.S. Federal Government
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