CINXE.COM
Nurse Practitioner, Clinical Nurse Specialist/Nephrology in Aurora, Colorado, CO for Veterans Affairs, Veterans Health Administration
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Please wait.</span> </div> </div> </div> <div class="bti-job-search-results" data-result-count="4"> <div class="card position-relative"> <div id="bti-job-20821947" class="card-body bti-job-search-row bti-job-results-highlighted" data-job-path="/jobs/20821947/nurse-practitioner-clinical-nurse-specialist-nephrology" data-job="20821947"> <div class="bti-grid-search-row no-gutters"> <div class="bti-grid-sidenav text-center"> <div class="card-img-holder"> <img class='img-fluid' itemprop='URL' src="/nsutilities/showLogo.cfm?id=8DF0C438-B70A-6674-A496-8CC021D408A3&orgType=employer&logoType=Primary" border="0" id="bti-Primary-8DF0C438-B70A-6674-A496-8CC021D408A3" alt="Veterans Affairs, Veterans Health Administration Logo"> </div> </div> <div class="bti-grid-search-contentarea"> <div class="card-title"><a href="/jobs/20821947/nurse-practitioner-clinical-nurse-specialist-nephrology">Nurse Practitioner, Clinical Nurse Specialist/Nephrology</a></div> <div class="card-subtitle"> <span title="Featured Employer" class="fas fa-users" aria-hidden="true"></span> Veterans Affairs, Veterans Health Administration </div> <p class="card-text"> Aurora, Colorado, Colorado </p> </div> </div> </div> </div> <div class="card position-relative"> <div id="bti-job-20821913" class="card-body bti-job-search-row" data-job-path="/jobs/20821913/advanced-practice-nurse-neurology" data-job="20821913"> <div class="bti-grid-search-row no-gutters"> <div class="bti-grid-sidenav text-center"> <div class="card-img-holder"> <img class='img-fluid' itemprop='URL' src="/nsutilities/showLogo.cfm?id=8DF0C438-B70A-6674-A496-8CC021D408A3&orgType=employer&logoType=Primary" border="0" id="bti-Primary-8DF0C438-B70A-6674-A496-8CC021D408A3" alt="Veterans Affairs, Veterans Health Administration Logo"> </div> </div> <div class="bti-grid-search-contentarea"> <div class="card-title"><a href="/jobs/20821913/advanced-practice-nurse-neurology">Advanced Practice Nurse (Neurology)</a></div> <div class="card-subtitle"> <span title="Featured Employer" class="fas fa-users" aria-hidden="true"></span> Veterans Affairs, Veterans Health Administration </div> <p class="card-text"> Nashville, Tennessee, Tennessee </p> </div> </div> </div> </div> <div class="card position-relative"> <div id="bti-job-20806972" class="card-body bti-job-search-row" data-job-path="/jobs/20806972/psychiatric-mental-health-nurse-practitioner-pmhmp-residency-training-director" data-job="20806972"> <div class="bti-grid-search-row no-gutters"> <div class="bti-grid-sidenav text-center"> <div class="card-img-holder"> <img class='img-fluid' itemprop='URL' src="/nsutilities/showLogo.cfm?id=8DF0C438-B70A-6674-A496-8CC021D408A3&orgType=employer&logoType=Primary" border="0" id="bti-Primary-8DF0C438-B70A-6674-A496-8CC021D408A3" alt="Veterans Affairs, Veterans Health Administration Logo"> </div> </div> <div class="bti-grid-search-contentarea"> <div class="card-title"><a href="/jobs/20806972/psychiatric-mental-health-nurse-practitioner-pmhmp-residency-training-director">Psychiatric Mental Health Nurse Practitioner (PMHMP) Residency Training Director</a></div> <div class="card-subtitle"> <span title="Featured Employer" class="fas fa-users" aria-hidden="true"></span> Veterans Affairs, Veterans Health Administration </div> <p class="card-text"> Aurora, Colorado, Colorado </p> </div> </div> </div> </div> <div class="card position-relative"> <div id="bti-job-20803650" class="card-body bti-job-search-row" data-job-path="/jobs/20803650/nurse-practitioner-primary-care" data-job="20803650"> <div class="bti-grid-search-row no-gutters"> <div class="bti-grid-sidenav text-center"> <div class="card-img-holder"> <img class='img-fluid' itemprop='URL' src="/nsutilities/showLogo.cfm?id=8DF0C438-B70A-6674-A496-8CC021D408A3&orgType=employer&logoType=Primary" border="0" id="bti-Primary-8DF0C438-B70A-6674-A496-8CC021D408A3" alt="Veterans Affairs, Veterans Health Administration Logo"> </div> </div> <div class="bti-grid-search-contentarea"> <div class="card-title"><a href="/jobs/20803650/nurse-practitioner-primary-care">Nurse Practitioner - Primary Care</a></div> <div class="card-subtitle"> <span title="Featured Employer" class="fas fa-users" aria-hidden="true"></span> Veterans Affairs, Veterans Health Administration </div> <p class="card-text"> Cape Coral, Florida, Florida </p> </div> </div> </div> </div> </div> </div> <div id="bti-grid-searchDetails" class="bti-grid-searchDetails" aria-live="polite"> <div id="bti-detail-loading" class="visually-hidden d-flex justify-content-center"> <div class="spinner-border" role="status"> <span class="sr-only">Loading... Please wait.</span> </div> </div> <div class="bti-job-detail-pane" id="bti-search-detail"> <script type="application/ld+json"> {"@context":"http://schema.org","baseSalary":{"currency":"USD","@type":"MonetaryAmount","value":{"unitText":"YEAR","@type":"QuantitativeValue","value":"Open"}},"industry":["Other / Not Specified"],"jobLocation":{"@type":"Place","address":{"addressRegion":"Colorado","@type":"PostalAddress","addressLocality":"Aurora, Colorado","addressCountry":"USA"}},"educationRequirements":"","url":"https://jobs.healthcareercenter.com/jobs/20821947/nurse-practitioner-clinical-nurse-specialist-nephrology","employmentType":"OTHER","image":"https://jobs.healthcareercenter.com/nsutilities/showLogo.cfm?id=1187208&orgType=employer&logoType=Primary","hiringOrganization":{"@type":"Organization","id":"http://vacareers.va.gov","url":"http://vacareers.va.gov","name":"Veterans Affairs, Veterans Health Administration"},"description":"The Eastern Colorado VA Healthcare System is recruiting for a Nurse Practitioner-Clinical Nurse Specialist/Nephrology at the Aurora, CO clinic. The Advanced Practice Nurse (APN) II Clinical Nurse Specialist (CNS) practices in the Nephrology Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The CNS provides advanced clinical practice, consultation, and management. Advanced Practice Nurse (Nurse Practitioner) Basic Requirements Education: A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a 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). NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the nurse practitioner degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent nurse practitioner masters or doctorate level degrees who possess current, full, active, and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment. License and Certification: License. All APN (NPs) must possess and maintain an active, current, full, and unrestricted APN license to practice as an NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia. Basic Certification. All APN (NPs) must maintain full and current board certification in an area of clinical specialty from one of the following: the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Board (AANPCB), or other nationally recognized certifying body in the area in which the Nurse Practitioner is academically prepared. NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (NP) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Advanced Practice Nurse (Clinical Nurse Specialist) Basic Requirements Education. A post-master's certificate or masters or doctoral degree as a clinical nurse specialist. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a 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) NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the CNS degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent CNS post-masters, masters, or doctorate level degrees who possess current, full, active and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment. Licensure and Certification. The following licensure and certification requirements are considered conditions of employment. License. All APN (CNSs) must possess and maintain an active, current, full and unrestricted license to practice as a CNS, or equivalent, in a State, Territory, or Commonwealth of the United States, or in the District of Columbia. Certification. All APN (CNSs) must maintain full and current board certification in an area of clinical specialty. Certification must be obtained through the American Nurses Credentialing Center (ANCC), American Association of Critical-Care Nurses (AACN), or another nationally recognized certifying body. NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (CNS) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Clinical Nurse Specialist) II: Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Graduate Nurse Technician Clinical Nurse Specialist on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. 搂 7405(c)(2)(B) Scope: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. Education and Experience Requirement: Meets basic education requirement for APN (CNS). Nurse II is considered the entry grade level for APN (CNSs); no experience is required. Dimension Requirement: APN (CNSs) at grade II are expected to meet the following dimension requirements: Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population, or program. Outcome Focus. Utilizes research and evidence-based practice to evaluate the patient care delivery system within a patient panel or program, presents findings and contributes to changes that enhance the quality and timeliness of veteran/patient care. Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care. Professional Development. Acquires knowledge and skills to develop expertise in area of practice. Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes. Physical Requirements: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs. Must complete annual Employee Health requirements, such as annual TB screening or testing, as a condition of employment. [\"The Advanced Practice Nurse (APN) II Clinical Nurse Specialist (CNS) practices in the Nephrology Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The CNS provides advanced clinical practice, consultation, and management. The CNS has prescriptive authority for a panel of patients or program as indicated by their position. The CNS is a licensed independent practitioner with advanced education and national certification who provides evidence-based care for a population of patients. Independently practices as a CNS providing a full range of services utilizing treatment guidelines in the delivery of high-quality care. Collaborates with patients, families, and health care practitioners to develop, implement, and evaluate care. Utilizes customer service principles, supports veteran self-determination, and serves as a resource for patients and staff in addressing ethical issues. The CNS reports to the Nephrology Section Chief, under the Chief of Medicine in the Medicine Service Line. Ultimately, the position is responsible to the Associate Director for Patient Care Services. The CNS is responsible for self-directed performance of the approved clinical privileges. Responsibilities include, but not limited to: Independently manages a panel of patients with acute and chronic health conditions with an emphasis on health promotion and disease prevention using evidence-based practice. Develops and implements an individualized plan to achieve optimal population health and disease management. Demonstrates leadership and works collaboratively with the interdisciplinary team. Orders and interprets labs, tests, and diagnostic studies. Prescribes pharmacologic and non-pharmacologic interventions. Makes appropriate referrals for patients and families. Initiates referrals/consults to specialty services. Provides education to patients and their families. Assesses and adjusts the plan of care as needed to achieve optimal patient outcomes. Exemplifies the ICARE core values of-Integrity, Commitment, Advocacy, Respect, and Excellence. Continue and further the development of the Nephrology Program. All other assigned duties. 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: 8:00am to 4:30pm, Monday through Friday Telework: Ad-hoc\"] <p /> <p />","@type":"JobPosting","responsibilities":"<p />","validThrough":"2024-12-21T00:00:00-05:00","title":"Nurse Practitioner, Clinical Nurse Specialist/Nephrology","datePosted":"2024-11-20T02:57:47-05:00"} </script> <script> window.dataLayer = window.dataLayer || []; dataLayer.push( { page: { pageInfo: { employmentType: 'OTHER', page_type: 'Careers', customer_type:'Job Seeker', site_section: 'Job Seekers', user_email:'', industry: 'Other / Not Specified', job_location: 'Aurora, Colorado, Colorado', education_requirements: '', base_salary: 'Open', job_url: 'https://jobs.healthcareercenter.com/jobs/20821947/nurse-practitioner-clinical-nurse-specialist-nephrology', employment_type: '', job_title: 'Nurse Practitioner, Clinical Nurse Specialist/Nephrology', job_experience_level: '' } } } ); 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The Advanced Practice Nurse (APN) II Clinical Nurse Specialist (CNS) practices in the Nephrology Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The CNS provides advanced clinical practice, consultation, and management. Advanced Practice Nurse (Nurse Practitioner) Basic Requirements Education: A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a 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). NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the nurse practitioner degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent nurse practitioner masters or doctorate level degrees who possess current, full, active, and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment. License and Certification: License. All APN (NPs) must possess and maintain an active, current, full, and unrestricted APN license to practice as an NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia. Basic Certification. All APN (NPs) must maintain full and current board certification in an area of clinical specialty from one of the following: the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Board (AANPCB), or other nationally recognized certifying body in the area in which the Nurse Practitioner is academically prepared. NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (NP) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Advanced Practice Nurse (Clinical Nurse Specialist) Basic Requirements Education. A post-master's certificate or masters or doctoral degree as a clinical nurse specialist. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a 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) NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the CNS degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent CNS post-masters, masters, or doctorate level degrees who possess current, full, active and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment. Licensure and Certification. The following licensure and certification requirements are considered conditions of employment. License. All APN (CNSs) must possess and maintain an active, current, full and unrestricted license to practice as a CNS, or equivalent, in a State, Territory, or Commonwealth of the United States, or in the District of Columbia. Certification. All APN (CNSs) must maintain full and current board certification in an area of clinical specialty. Certification must be obtained through the American Nurses Credentialing Center (ANCC), American Association of Critical-Care Nurses (AACN), or another nationally recognized certifying body. NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (CNS) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Clinical Nurse Specialist) II: Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Graduate Nurse Technician Clinical Nurse Specialist on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. 搂 7405(c)(2)(B) Scope: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. Education and Experience Requirement: Meets basic education requirement for APN (CNS). Nurse II is considered the entry grade level for APN (CNSs); no experience is required. Dimension Requirement: APN (CNSs) at grade II are expected to meet the following dimension requirements: Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population, or program. Outcome Focus. Utilizes research and evidence-based practice to evaluate the patient care delivery system within a patient panel or program, presents findings and contributes to changes that enhance the quality and timeliness of veteran/patient care. Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care. Professional Development. Acquires knowledge and skills to develop expertise in area of practice. Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes. Physical Requirements: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs. Must complete annual Employee Health requirements, such as annual TB screening or testing, as a condition of employment. ["The Advanced Practice Nurse (APN) II Clinical Nurse Specialist (CNS) practices in the Nephrology Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The CNS provides advanced clinical practice, consultation, and management. The CNS has prescriptive authority for a panel of patients or program as indicated by their position. The CNS is a licensed independent practitioner with advanced education and national certification who provides evidence-based care for a population of patients. Independently practices as a CNS providing a full range of services utilizing treatment guidelines in the delivery of high-quality care. Collaborates with patients, families, and health care practitioners to develop, implement, and evaluate care. Utilizes customer service principles, supports veteran self-determination, and serves as a resource for patients and staff in addressing ethical issues. The CNS reports to the Nephrology Section Chief, under the Chief of Medicine in the Medicine Service Line. Ultimately, the position is responsible to the Associate Director for Patient Care Services. The CNS is responsible for self-directed performance of the approved clinical privileges. Responsibilities include, but not limited to: Independently manages a panel of patients with acute and chronic health conditions with an emphasis on health promotion and disease prevention using evidence-based practice. Develops and implements an individualized plan to achieve optimal population health and disease management. Demonstrates leadership and works collaboratively with the interdisciplinary team. Orders and interprets labs, tests, and diagnostic studies. Prescribes pharmacologic and non-pharmacologic interventions. Makes appropriate referrals for patients and families. Initiates referrals/consults to specialty services. Provides education to patients and their families. Assesses and adjusts the plan of care as needed to achieve optimal patient outcomes. Exemplifies the ICARE core values of-Integrity, Commitment, Advocacy, Respect, and Excellence. Continue and further the development of the Nephrology Program. All other assigned duties. 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: 8:00am to 4:30pm, Monday through Friday Telework: Ad-hoc"] <P> <P> <div class="bti-send-me-job-alerts pe-3 d-print-none"> <a rel="nofollow" href="/login/?returnURL=spn.nationalhealthcarecareers.com%2Fjobs%2Falerts%3Fkeywords%3DNurse%2520or%2520Practitioner%2520or%2520Clinical%2520or%2520Nurse%2520or%2520SpecialistNephrology%26jobAlertTitle%3DJobs%2520Similar%2520To%2520Nurse%2520Practitioner%252C%2520Clinical%2520Nurse%2520Specialist%252FNephrology%26cmd%3Dalert" id="bti-results-save" class="bti-btn bti-btn-lg bti-btn-primary mt-3 bti-ui-email-jobs-button text-white w-100"><i class="far fa-envelope"></i> Create a Job Alert for Similar Jobs</a> </div> <div class="bti-jd-employer-container bti-grid-row"> <div class="bti-jd-employer bti-grid-col py-3"> <div itemscope itemtype="https://schema.org/Organization"> <div class="my-3"> <a href="/profiles/1187208/veterans-affairs-veterans-health-administration/?orgID=318359&page=job-detail&zone=employer-job-detail&Campaign=Premium%20Employer" rel="nofollow"><img class='img-fluid' itemprop='URL' src="/nsutilities/showLogo.cfm?id=1187208&orgType=employer&logoType=Primary" border="0" id="bti-Primary-1187208" align="middle" alt="Employer Logo"><span style="display:none;">Logo</span></a> </div> <div class="bti-jd-about-title" itemprop="name">About <a href="/profiles/1187208/veterans-affairs-veterans-health-administration/?orgID=318359&page=job-detail&zone=employer-job-detail&Campaign=Premium%20Employer" rel="nofollow">Veterans Affairs, Veterans Health Administration</a></div> <div class="bti-jd-detail-text mb-3"> <div class="bti-jd-employer-info" itemprop="description"> The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care at 1,321 health care facilities, including 172 VA Medical Centers and 1,138 outpatient sites of care of varying complexity (VHA outpatient clinics) to over 9 million Veterans enrolled in the VA health care program. 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