The registered nurse in the RN-Coordinated Transitional Care Program (RN- C-TraC) identifies patients at high risk for readmission or increased need for non-institutional support services. He/she will assist with patient discharge and provide intensive coordination of post-discharge care. He/she will assist Veterans transitioning from acute hospital admissions, and Long Term Care stays, back to VA primary care through enhanced integration with our Patient Aligned Care Team (PACT) teams.
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.
