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Job Title: Registered Nurse (rn) Assistant Nurse Manager Medical Oncology Telemetry 5n Job in DENVER, CO
Company: Federal Government Jobs
Location: Denver, CO

Description:
Job Description (Please follow all instructions carefully) Department:Department Of Veterans AffairsAgency:Veterans Health AdministrationSub Agency:Eastern Colorado Health Care SystemJob Announcement Number:09-482Job Title:Registered Nurse: Assistant Nurse Manager, Medical/Oncology/Telemetry/ (5N)Salary Range:63,639.00 - 84,638.00 USD /yearSalary determined by Nurse PSB based on Education, Experience and Credentials.Series & Grade:VN-0610-0Open Period:Wednesday, December 02, 2009 to Monday, May 24, 2010Position Information:Full-Time, this position will require working primarily eight hour day shift  and other shifts as needed.  PermanentDuty Locations:1 vacancy - Denver, CO Who May Be Considered:Applications will be accepted from United States citizens and nationals.Job Summary:A vacancy exists for an Assistant Nurse Manager for the 27 bed Medical/Telemetry/Oncology Unit (5N). The goal of the Unit is to provide compassionate, quality and safe patient care. The Assistant Nurse Manager will assist the Nurse Manager with administration, management, supervision and evaluation of nursing personnel, patient care programs and staff activities. Key Requirements: U.S. Citizenship Major Duties: The incumbent will be responsible for assisting the Nurse Manager with the day-to-day operations of the unit. Primary duties include but not limited to 1) Coordinating patient care through staff assignments, 2) Acting as liaison between the nursing staff and the medical and ancillary staff, 3) Evaluating and documenting performance of nursing and ancillary personnel, 4) Coordinating educational programs to assist staff in improving their performance, 5) Modeling the utilization of evidence based research to improve practice and 6) Promoting an environment that fosters employees to perform to their full potential. Qualifications: BASIC REQUIREMENTS: (1)  Citizen or national of the United States (2)  English Language Proficiency:  If you are appointed to a direct patient care position, you must be proficient in spoken and written English as required by 38 U.S.C. 7402 (d) and 7407 (d). (3)   Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory, or Commonwealth (i.e., Puerto Rico) of the U.S. or in the District of Columbia.  EDUCATION REQUIREMENTS: (1)  Graduate of a school of professional nursing approved by the appropriate State agency and accredited by one of the accrediting bodies at the time the program was completed. (2) BSN (National League for Nursing Accrediting Commission) (NLNAC) or Commission on Collegiate Nursing Education (CCNE) accredited). (1)  Three years of current medical/surgical and/or critical care nursing experience. (2)  Documented evidence of high satisfactory performance and attendance. (3)  Demonstrated ability to develop and maintain effective interpersonal relationships. (4)  Demonstrated ability to provide leadership in delivering and improving holistic care through collaborative strategies with others. (5)  Demonstrated ability to interpret and communicate Nursing and ECHCS goals, objectives, policies, and procedures to staff, patients, and the health care team. (6)  Ability to communicate clearly and concisely verbally and in writing. (7)  Documented evidence utilizing problem-solving methodologies to resolve system and/or process problems that impact patient care or staff performance. (8)  Demonstrated leadership in teaching, counseling and advising staff in patient care issues.  You must be a U.S. citizen to qualify for this position.How You Will Be Evaluated: BASIS OF RATING:  An application, which shows that the applicant meets the qualification requirements and is eligible for appointment, will be rated on the basis of experience (including volunteer work), education, training, and awards which are related to the position. In order to assess the nature and extent of your professional experience, please provide responses to the following on a separate sheet of paper. This will be submitted to the Nurse Professional Standards Board to assist in your grade determination.  Please provide at least one example and one outcome for each question. 1. How has your education/experience prepared you to effectively use the nursing process components of assessment, diagnosis, outcome identification, planning, implementation and evaluation in varied practice settings? (Practice) 2. In your education/practice, how have you systematically evaluated and improved the quality and effectiveness of your nursing practice and health care delivery?  (Quality of Care) 3.  Have you had the opportunity to evaluate your own nursing practice and the performance of others?  (Performance) 4.  How have you used current knowledge to develop yourself and others? (Educational/Career Development) 5.  Please tell how you have contributed to the professional development of yourself and others.  (Collegiality) 6.  Please describe an ethical situation you were involved in and how you made your decision and took action.  (Ethics) 7.  Please describe interpersonal skills you possess that allow you to work well with others.  (Collaboration) 8.  Please describe how you use research in your practice.  (Research) 9.  How do you incorporate safety, effectiveness and cost in planning and delivering care?  (Resource Utilization)  Benefits:You may participate in the Federal Employees Health Benefits program, with costs shared with your employer. More info: http://www.usajobs.gov/jobextrainfo.asp#FEHB.Life insurance coverage is provided. More info: http://www.usajobs.gov/jobextrainfo.asp#lifeNew employees are automatically covered by the Federal Employees Retirement System (FERS). If you are transferring from another agency and covered by CSRS, you may continue in this program. More info: http://www.usajobs.gov/jobextrainfo.asp#retrYou will earn annual vacation leave. More info: http://www.usajobs.gov/jobextrainfo.asp#VACAYou will earn sick leave. More info: http://www.usajobs.gov/jobextrainfo.asp#SKLVYou will be paid for federal holidays that fall within your regularly scheduled tour of duty. More info: http://www.usajobs.gov/jobextrainfo.asp#HOLIOther Information: CONDITIONS OF EMPLOYMENT: 1.  All Non-VA applicants tentatively selected for VA employment in any 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. 2.  Subject to suitability determination. 3.  Employees who occupy a Testing Designated Position are subject to random testing. 4.  A pre-employment medical examination is required. How To Apply:You must submit your application so that it will be received by the closing date of the announcement. INTERNAL CANDIDATES (EMPLOYEES CURRENTLY EMPLOYED AT THE EASTERN COLORADO HEALTH CARE SYSTEM): Internal candidates interested in this position need to submit an internal application packet directly to the Shelli Kriley, MSA, RN Nurse Recruiter (05).  The internal application packet includes: 1) Memo requesting consideration for the position with contact telephone numbers, 2) Resume, and 3) Last two proficiency reports which validate or support qualifications. EXTERNAL CANDIDATES: 1.  Application for Nurses and Nurse Anesthetists, VA Form 10-2850a.  This form is available on www.usajobs.gov.  2.  Declaration for Federal Employment, OF-306, is required.  This form is available at www.usajobs.gov.  3.  Resume, which includes a listing of each job, dates employed, the employer's full name and address, your title, immediate supervisor's name and telephone number, hours worked weekly, and a detailed description of duties performed.  The resume must account for all times since you completed your professional education, including periods of unemployment and school.  4.  College Transcripts.  Recent graduates (up to 14 months) and graduates




Job Title: Nursing Supervisor
Company:
Location: Fort Collins, CO

Description:
This is a full time, salaried position in a home health agency. Home health care experience is required. Good benefits. Contact Sheri Sauer, Director of Patient Services in our FC office: Register to View or fax your resume to her attention at Register to View .




Job Title: Nurse Managers
Company: Denver VA Medical Center
Location: Denver, CO

Description:
Rehab/Palliative/Transitional Care (5 South), OR - Amb. Surg (Co Sp), Surg/Tele (4 South) The incumbent will be responsible for assisting the Nurse Manager with the day-to-day operations of the unit. Primary duties include but not limited to 1) Coordinating patient care through staff assignments, 2) Acting as liaison between the nursing staff and the medical and ancillary staff, 3) Evaluating and documenting performance of nursing and ancillary personnel, 4) Coordinating educational programs to assist staff in improving their performance, 5) Modeling the utilization of evidence based research to improve practice and 6) Promoting an environment that fosters employees to perform to their full potential.




Job Title: Nurse Manager - ER
Company: Quantum Advantage Inc.
Location: Fort Collins, CO

Description:
Located at the base of the Rocky Mountains and blessed with over 300 days of sunshine each year, this college town is home 80,000 permanent residents who participate in a variety of agri-business, education, governmental and health related industries which form a foundation for a strong and growing population. Excellent schools and extensive participation in community based activities are the backbone of the entire area. You can enjoy the benefits of small town living: friendly neighbors, tree lined streets and no traffic congestion while having the best of urban amenities in Denver and the best of mountain recreation in the Rockies, all within a short drive. Think Colorado for your family and your future! Our hospital offers clinical services that reflect the warmth and personalized atmosphere of a small-town hospital, with the sophistication and cutting-edge technology commonly found only in much larger urban hospitals. At the heart of healthcare at our hospital is the desire to offer access to a broad range of high-quality services - from behavioral health to oncology and cardiac care. And our goal is not only to meet the expectations of those we serve, but also to exceed them every single day. We are seeking a Senior Emergency Room Nurse Manager for a 9 bed Emergency Department. Must have at least 3-5 years management experience in ER setting. Must possess a strong knowledge of nursing and healthcare as normally demonstrated through the completion of a bachelor?s degree in nursing. Requires a current RN license in state of Colorado. Must possess a strong knowledge and understanding of clinical care management as normally demonstrated through 3-5 years of clinical management experience relevant to patient population. Demonstrates knowledge and skills of specialty area. Note: This field is limited to 2,000 characters. The rest of this position description will be found at the beginning of the qualifications field.df-lj




Job Title: Nurse Manager #1033836
Company: Kaiser Permanente - Colorado
Location: Denver, CO

Description:
JOB SUMMARY: Responsible for patient focused, quality, effective, efficient, nursing care andservice behaviors of Operating Room (OR) staff supporting the practices of physicians and othermedical providers. Accountable for role clarity, communication, and performance management of OR staff so that the staff is best able to participate successfully as members of care teams. Supervises and coordinates the activities of OR personnel engaged in providing patient focusednursing care and related medical services in support of the physician practices in the medicaloffices. Partners with the physician leaders in creating a culture of commitment to patient focusedservice, excellent support of physician practices, innovation, compliance, ethics and integrity. Accountable for creating a culture of compliance, ethics and integrity. Maintains knowledge of andassures departmental compliance with Kaiser Permanente�s Principles of Responsibility and policiesand procedures, and applicable regulatory requirements and accreditation standards. Respondsappropriately, including required reporting, to observed fraud or abuse.POSITION REQUIREMENTS: Licensed as a Registered Nurse in the State of Colorado. Must be a graduateof a RN program that meets Colorado State Board of Nursing curriculum requirements. Bachelor�s degree required. Highly prefer Bachelor�s degree in Nursing. Three years of nursing leadershipexperience required.Three years of experience in an operating room required. Certified RegisteredNursing Operating Room preferred. Basic Life Support Certification (BLS) strongly preferred. Strongwritten, verbal and interpersonal communication skills required. Demonstrated ability to write & setdepartmental policies, procedures & standards. Demonstrated ability to forecast & manage budgets.Knowledge of regulatory agency requirements for ambulatory surgery, infection control, OSHA, AORNstandards & AAMI standards. Working knowledge of computer systems.ESSENTIAL RESPONSIBILITIES: Supervises, leads, role models and coordinates the activities ofOperating Room personnel engaged in providing excellent patient focused care and supportingphysician practices through the provision of integrated, effective and innovative nursing practicesand related medical services. Interviews, selects, evaluates, motivates, orients, trains,coaches\counsels, disciplines and terminates personnel in collaboration with physician leaders andin compliance with requirements of EEO/AA goals, union contracts, and personnel policies of theorganization. Continually improves service and staff productivity. Improves quality in partnershipwith CPMG. Monitors, identifies and investigates competency issues and service or support deficitsassociated with daily operations and overall patient care within the unit(s) and develops andadministers corrective measures in collaboration with Permanente physicians to ensure safe andefficient working conditions. Acts as a liaison between the physician group, the patient care unit,and the call center to ensure effective communication for overall patient care services.Collaborates with other facility leaders to design systems for providing high quality patient careservices. Ensures highest nursing standards and monitors clinical nursing practice and documentationwithin the department to meet and/or exceed appropriate nursing and licensing/accrediting agencyguidelines and/or standards. Is accountable for outstanding support of physician practices. Thenurse manager collaborates with the physician and the physician manager in managing labor relations.Coordinates and adheres to budgetary needs for operation of the unit in collaboration with medicalgroup leaders. Monitors quality assurance projects in collaboration with physician group. Maintaincurrent information and knowledge of all applicable Kaiser Permanente policies, local, state andfederal laws and regulations, and accreditation standards. Ensures that the training activitiesincorporate all applicable KP policies, local, state and federal laws and regulations, andaccreditation standards. Position requires working with interruptions, occasionally working withbio-hazardous waste, and working around machinery and moving equipment, such as wheel chairs.Standard medical office environment. May be required to lift patients using proper liftingtechnique.For Essential Responsibilities: In addition to defined technical requirements, accountable forconsistently demonstrating service behaviors and principles defined by the Kaiser Permanente ServiceQuality Credo, the KP Mission as well as specific departmental/organizational initiatives. Alsoaccountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessaryto provide superior and culturally sensitive service to each other, to our members, and topurchasers, contracted providers and vendors.Functional and Environmental Factors available upon request.SCHEDULE: Variable Hours & Days STARTING SALARY RANGE: $5,650 - $7,353 (Monthly)- Kaiser Permanente is an AA/EEO employer -




Job Title: Registered Nurse (rn) Assistant Nurse Manager Psychiatric Residential Rehabilitation Treatment Program Job in DENVER, CO
Company: Federal Government Jobs
Location: Denver, CO

Description:
Job Description (Please follow all instructions carefully) Department:Department Of Veterans AffairsAgency:Veterans Health AdministrationSub Agency:Eastern Colorado Health Care SystemJob Announcement Number:09-515Job Title:Registered Nurse: Assistant Nurse Manager, Psychiatric Residential Rehabilitation Treatment ProgramSalary Range:63,639.00 - 84,638.00 USD /yearSalary determined by Nurse PSB based on Education, Experience and Credentials and Location.Series & Grade:VN-0610-0Open Period:Wednesday, December 23, 2009 to Wednesday, June 30, 2010Position Information:Full-Time,  primarily 8 hour days, but will include rotation to other shifts as needed. PermanentDuty Locations:1 vacancy - Denver, CO Who May Be Considered:Applications will be accepted from United States citizens and nationals.  Nationals MUST provide proof of citizenship. Job Summary: First referral cut-off date will be January 9, 2010.  Vacancy exists for a full-time Assistant Nurse Manager at the 19 bed PRRTP unit at the Denver VA Medical Center.  Key Requirements: U.S. Citizenship Major Duties: The Assistant Nurse Manager must demonstrate leadership in delivering and improving holistic care through collaborative strategies with others.  The Assistant Nurse Manager will assist the Nurse Manager with administration, management, supervision and evaluation of nursing personnel, patient care programs and staff activities.  The Assistant Nurse Manager will be responsible for assisting the Nurse Manager with the day-to-day operations of the psychiatric unit by coordinating patient care through staff assignments, acting as liaison between the nursing staff and the medical and ancillary staff, evaluating and documenting performance of nursing and ancillary personnel, assisting with coordination of educational programs to assist staff in improving their performance, modeling the utilization of evidence based research to improve practice, promoting an environment that fosters employees to perform to their full potential, and ensuring a safe environment of care.Qualifications: BASIC REQUIREMENTS: (1)  Citizen of the United States (2)  English Language Proficiency:  If you are appointed to a direct patient care position, you must be proficient in spoken and written English as required by 38 U.S.C. 7402 (d) and 7407 (d). (3)   Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory, or Commonwealth (i.e., Puerto Rico) of the U.S. or in the District of Columbia.  EDUCATION REQUIREMENTS: 1.    Graduate of a school of professional nursing approved by the appropriate state agency and accredited by one of the accrediting bodies at the time the program was completed. 2.     BSN (National League for Nursing Accrediting Commission) (NLNAC) or Commission on Collegiate Nursing Education (CCNE) accredited. 1.    Three years of progressive leadership experience.2.    Documented evidence of highly satisfactory performance and attendance.3.    Demonstrated ability to execute position responsibilities with leadership, experience, and creative approaches to management of complex care.4.    Demonstrated ability to develop and maintain effective interpersonal relationships and communication with staff throughout the health care system and community. 5.    Ability to collaborate effectively with others to use the group process to identify, analyze, and resolve problems. 6.    Ability to communicate clearly and concisely verbally and in writing. 7.    Demonstrates knowledge of accrediting bodies and regulatory standards related to long-term care. 8.    Demonstrated ability to interpret and communicate goals, objectives, policies and procedures to staff, patients, and the healthcare team.  You must be a U.S. citizen to qualify for this position.How You Will Be Evaluated: BASIS OF RATING:  An application, which shows that the applicant meets the qualification requirements and is eligible for appointment, will be rated on the basis of experience (including volunteer work), education, training, and awards which are related to the position. In order to assess the nature and extent of your professional experience, please provide responses to the following on a separate sheet of paper. This will be submitted to the Nurse Professional Standards Board to assist in your grade determination.   Please provide at least one example and one outcome for each question. 1. How has your education/experience prepared you to effectively use the nursing process components of assessment, diagnosis, outcome identification, planning, implementation and evaluation in varied practice settings? (Practice) 2. In your education/practice, how have you systematically evaluated and improved the quality and effectiveness of your nursing practice and health care delivery?  (Quality of Care) 3.  Have you had the opportunity to evaluate your own nursing practice and the performance of others?  (Performance) 4.  How have you used current knowledge to develop yourself and others? (Educational/Career Development) 5.  Please tell how you have contributed to the professional development of yourself and others.  (Collegiality) 6.  Please describe an ethical situation you were involved in and how you made your decision and took action.  (Ethics) 7.  Please describe interpersonal skills you possess that allow you to work well with others.  (Collaboration) 8.  Please describe how you use research in your practice.  (Research) 9.  How do you incorporate safety, effectiveness and cost in planning and delivering care?  (Resource Utilization)  Benefits:You may participate in the Federal Employees Health Benefits program, with costs shared with your employer. More info: http://www.usajobs.gov/jobextrainfo.asp#FEHB.Life insurance coverage is provided. More info: http://www.usajobs.gov/jobextrainfo.asp#lifeNew employees are automatically covered by the Federal Employees Retirement System (FERS). If you are transferring from another agency and covered by CSRS, you may continue in this program. More info: http://www.usajobs.gov/jobextrainfo.asp#retrYou will earn annual vacation leave. More info: http://www.usajobs.gov/jobextrainfo.asp#VACAYou will earn sick leave. More info: http://www.usajobs.gov/jobextrainfo.asp#SKLVYou will be paid for federal holidays that fall within your regularly scheduled tour of duty. More info: http://www.usajobs.gov/jobextrainfo.asp#HOLIOther Information: CONDITIONS OF EMPLOYMENT: 1.  All Non-VA applicants tentatively selected for VA employment in any 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. 2.  Subject to suitability determination. 3.  Employees who occupy a Testing Designated Position are subject to random testing. 4.  A pre-employment medical examination is required.How To Apply:You must submit your application so that it will be received by the closing date of the announcement. INTERNAL CANDIDATES (EMPLOYEES CURRENTLY EMPLOYED AT THE EASTERN COLORADO HEALTH CARE SYSTEM) Individuals interested in this position need to submit an internal application packet directly to Shelli Kriley, MSA, RN,  Nurse  Recruiter, Human Resources (05).  The internal application packet includes: 1) Memo requesting consideration for the position with contact telephone numbers, 2) Resume, and 3) Last two proficiency reports which validate or support qualifications. EXTERNAL CANDIDATES: 1.  Application for Nurses and Nurse Anesthetists, VA Form 10-2850a.  This form is available on www.usajobs.gov.  2.  Declaration for Federal Employment, OF-306, is required.  This form is available at www.usajobs.gov.  3.  Resume, which includes a listing of each job, dates employed, the employer's full name and address, your title, immediate supervisor's name and telephone number, hours worked weekly, and a detailed descr




Job Title: RN Supervisor
Company: Western Hills Health Care Center
Location: Lakewood, CO

Description:
Western Hills Health Care Center is Hiring! RN Supervisor Full-Time, Evenings Join the Nation's Largest Privately-Owned Skilled Care Provider!




Job Title: Nurse Manager Geriatric Behavioral Health Unit
Company: Hospital Jobs Online
Location: Fort Morgan, CO

Description:
Company: Deegan, Fernandez & Associates, Inc Title: Nurse Manager Geriatric Behavioral Health Unit JobID: Register to View 3719 City: Fort Morgan State: CO Description: HOURS: Full-time position Looking for a community "big enough to have it all, and small enough to be a delightful hometown?" That's the way folks around here describe Fort Morgan, Colorado. Just 90 miles east of the Rocky Mountains and a little over an hour's drive from Denver on Interstate 76, this friendly town offers convenient access to some of America's best ski resorts and the rich cultural life of the Mile High City. The nearby Rocky Mountains are world renowned for their gold-medal fly-fishing and winter sports. Prime hunting areas for deer, antelope, pheasant, turkey, grouse, quail, duck and geese are plentiful around Fort Morgan. Pawnee Buttes National Grasslands, a 30-minute drive north, is a hiker's and photographer's paradise, and Jackson State Park and Reservoir offers boating, water skiing, and fishing. The city of Fort Morgan supports a strong city recreation program, including a challenging 18-hole municipal golf course. The 77-acre Riverside Park has playgrounds, horseshoe pits, skating rink, swimming pool, fitness trails, duck ponds, and facilities for volleyball, basketball and baseball, all adjacent to a 240-acre natural area with walking trails.




Job Title: RN WEEKEND NURSE MANAGER
Company:
Location: Colorado Springs, CO

Description:
Parkmoor Village Healthcare Center is located in northeast Colorado Springs. Our team of highly trained nurses and therapists provide compassionate and excellent care in a state of the art environment. We are looking for an exceptional weekend Nurse Manager to foster and promote quality care and services by joining our dynamic, dedicated and fun-loving team. The Nurse Manager will: 1) Be in charge of the facility in the absence of the Director of Nursing and Assistant Director of Nursing 2) Be a resource for other departments within the established guidelines of the facility in the absence of other administrative personnel 3) Consult other nursing personnel in making clinical and administrative decisions 4) Monitor the quality of nursing care to all patients/residents by working through and with the Unit Charge Nurse 5) Evaluate the performance of licensed nurses that report directly to the nursing supervisor 6) Adequately staff the facility nursing units 7) Handle employee health issues that arise on shift in compliance with facility policy and procedures 8) Perform other functions as directed by the Director of Nursing or the Administrator 9) Participate in the quality assessment and improvement process and activities Job Requirements: - Current RN license in CO - Two years minimum clinical and supervisory experience in a LONG-TERM CARE / SKILLED NURSING FACILITY - Excellent interpersonal and time management skills We offer a competitive wage and full benefit package. Please submit your resume for immediate consideration




Job Title: Nurse Manager ICU
Company: Hospital Corporation of America
Location: Denver, CO

Description:
New 24 bed ICU in Denver. Ideal candidate will have previous/current leadership experience in Critical care Nursing.Position Summary: The Nurse Manager provides leadership through planning, organizing, coordinating, monitoring and evaluating the care provided for patients. The delivery of care is based on criteria that is age appropriate and is based on the physical, psychosocial, cultural, safety, and learning needs of the individual patients. Responsibilities include fiscal, human resource, and operational functions. Maintains 24 hour accountability for patient care. The Nurse Manager performs delegated duties consistent with the scope of practice and functions within the philosophy and overall plan of care at Rose Medical Center. The Nurse Manager displays positive support for the values and mission of Rose Medical Center.II. Position Requirements:A. Licensure/Certification/Registration: Current Registered Nurse license in the State of Colorado.B. Education and Training: Bachelor Science of Nursing or Bachelors degree in health related field required. Master's Degree is encouraged. Graduate of an accredited school of nursing. Current BLS, ACLS and CCRN certification.C. Experience: Minimum of 5 years clinical experience required. Previous management experience required.D. Knowledge, Skills and Abilities: Demonstrates understanding of health care from an organizational system perspective. Demonstrates comprehensive knowledge of the practice of the nursing process. Demonstrates the ability to plan and provide for delivery of nursing services. Ability to recognize the needs and concerns of people and to maintain constructive relationships in all interactions. Ability to communicate effectively in oral and written manners. Participates in counseling and guidance of personnel. Ability to assume twenty-four hour responsibilities for integration of patient care. Ability to assume leadership role with the health care team in planning and delivery of patient care. Recognized personal responsibility in striving for innovative health care delivery and assumes leadership in negotiating for changes in health care.




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