The Utilization Management (UM) Nurse will function independently and is supervised by the UM Manager or Chief of Quality Service. Effectively communicates with physician, nurses and other health care providers in obtaining and verifying data for review and formulating a plan of care and will demonstrate leadership in delivering and improving holistic care through collaborative strategies with across services and departments to impact patient flow and proper utilization of resources. Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (Reference VA Handbook 5005, Appendix G6) OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing. Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Preferred Experience: Master of Science Degree in Nursing (MSN) Current/Recent Utilization RN Experience Current/Recent Quality RN Experience 3-5 Years RN Experience Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade: Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: The Edward Hines, Jr., VA Medical center is a major interdisciplinary teaching facility, serving medical, surgical, inpatients and outpatients. There is a large outpatient psychiatric population, with admissions for medical co-morbidities. This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continues walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. The incumbent may be exposed to infected patients and contaminated materials and may be required to don protective clothing in isolation situations or operative/invasive procedures. 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. ["VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Utilization Management (UM) RN demonstrates a high level of clinical practice, knowledge, and leadership skills to improve patient access, flow, and positively impact the facility utilization of services. The UM RN will be aligned within Quality Management Service and must work independently in accomplishing assignments and program goals. He/she possesses knowledge of utilization review criteria, UM processes and principles, clinical documentation requirements, current standards of care and compliance guidelines. As a clinical reviewer he/she serves as the QM liaison creating effective lines of communication with medical center leadership, staff, and internal/external customers. He/she collects, interprets and communicates pertinent clinical data, applies InterQual criteria and enters information into a National database. The responsibilities of the UM RN include all facets of UM and support of the QM functions including Performance Improvement, Performance Measures and facility visitors. Duties of this position directly affect the internal security of the agency. Internal security includes investigations/audits of patient care records for several purposes such as fact finding, sentinel events, surveillance, performance improvement, root cause analyses, FMEA, and regulatory agency requests (i.e., OIG, TJC, etc., ) which are imperative to the functional operation of the organization in carrying out its mission to improve health care for our veterans. The Utilization Management Nurse demonstrates leadership and uses collaborative strategies with others to meet the medical center mission. The Scope of Practice is defined by the dimensions outlined in VA Handbook 5005, Part II, Appendix G6 and specific to the grade and level for an RN. The dimensions of focus are:???????Utilizes sound clinical expertise, and interprets, evaluates clinical information accurately. Conducts clinical reviews effectively applies utilization review criteria, utilization management processes and principles in accordance with current standards of care and compliance guidelines Adheres to facility, VISN and National clinical documentation requirements. Works independently and completes assignments timely meeting program goals. Creates effective lines of communication and collegial, collaborative, and functional partnerships with leadership, all levels of staff, and internal/external visitors Initiates contact with providers and facility staff to address utilization issues related to admission, continued stay, and discharge information to optimize use of facility resources Communicates effectively, both orally and in writing, with internal and external customers. This includes leadership, professional staff, administrative and technical staff Demonstrates leadership by ensuring continuity of the utilization review activities, coordination with medical center policy, and in resolving problems to maximize reimbursement efforts Proficient technical skills- databases, VISTA, CPRS and Windows based programs. Develops clear concise reports Collects, analyzes, and interprets outcome data systematically to identify problem areas and assess need for improvement and/or to support changes in system, and organizational processes Provides appropriate orientation, education and continuing professional development of self and staff in Utilization Management/Quality Management Promotes excellence in customer service, internally/ externally by incorporating the VHA Core Values (Trust, Respect, Commitment, Compassion, and Excellence) into daily practice and performance Consistently models professional conduct in routine and stressful situations. Provides leadership in identifying and addressing ethical issues that impact clients and staff, including initiating and participating in ethics consultations. Manages program resources (financial, human, material, or informational) to facilitate safe, effective, and efficient care 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: Day Shift, Various Tours Available Compressed/Flexible: Not Authorized Telework: May be Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Financial Disclosure Report: Not Required"]
About Veterans Affairs, Veterans Health Administration
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.