November 2017
Non VA Care Coordination
at James A. Haley VA Hospital
James A. Haley VA Hospital
United States
Yvonne Carl, RN; Mary Hilbert, RN; Lori Santeramo, RN




The Non-VA Care Coordination (NVCC) department is a very fluid aspect of JAHVA. This department focuses on coordinating the care for Veterans in the community. The service is currently staffed with 10 RNs, with 5 of them having less than a year with the department. One of the biggest challenges at NVCC is there are always new directives coming down the pipe and the nurses, at times, must completely change their process. Three of the RNs at NVCC have been there for over 5 years. They have been instrumental in assisting those of us that are newer.  These non-VA Care RNs have the knowledge and expertise of the federal rules, regulations, processes, and competence for Community Care for the Veterans. There are changes to department processes on a daily basis with the advent of HealthNet and the Choice Program. These nurses educate, update and collaborate with all team members to ensure we have the most current knowledge of processing care in the Community Consults for our beloved Veterans. Having these team members has increased the processing of Non-VA Community Care Consults, decreased Veteran’s frustration with receiving Care in the Community and with the Community Providers where our Veterans receive the care.

The three RNs we want to recognize are Yvonne Carl, Mary Hilbert, and Lori Santeramo. They all bring something different to NVCC, but the goal remains the same: to make sure that the Veteran receives the appropriate care in a timely manner.

Ms. Santeramo is the go-to person when it comes to regulations. She can recite them effortlessly and applies them to all consults that she processes. She assists those of us that are still learning in applying them correctly. She is able to explain the federal rules and regulations to Veterans and VA employees alike.

Ms. Mary Hilbert brings a different dimension to NVCC. She can think outside the box to make sure that the Veteran gets the care he/she needs. Ms. Hilbert can also be heard, on many occasions, educating Veterans on their options and assists them in navigating the complex and confusing HealthNet system. Through all the challenges that are faced at NVCC, Ms. Hilbert brings a positive energy to the service.

Ms. Yvonne Carl encompasses the characteristics of both Ms. Hilbert and Ms. Santeramo. Her calm and encouraging demeanor can put any “newbie” at ease. Ms. Carl’s experience at NVCC has made her very proficient in verbiage and efficiency in understanding and processing consults. She is always willing to share tips and tricks to make us more efficient. She is always but a phone call or instant message away.

These RNs are always ready to assist anyone of us that may need assistance, guidance, or just a small push in the right direction. Within the last 2 years, they have trained 7 RNs, 5 of us in the last 6 months. With NVCC moving towards a case management model, there has been a decision to form teams. Ms. Carl, Ms. Hilbert, and Ms. Santeramo have been chosen as our team leaders. They make themselves available and are ready to assist anyone of us with anything we may need. What makes them even more remarkable, is they telework 4 days a week. Their accessibility to the Veterans and the department is invaluable and they perform their tasks from the heart. They are instrumental in the service as we move to a different model of operating. They apply the ICARE values of integrity, compassion, advocacy, respect and excellence in everything they do. These values are applied not only towards the Veterans, but towards their colleagues as well. Their goal is to make sure that all Veterans get the care they need and deserve in the most efficient way possible.

We thank you for your commitment to the Veterans and to NVCC. This department leans greatly on you as a source of reference, encouragement, and expertise.