Registered Nurse (Utilization Management) - EDRP Authorized

Full Job Description

The VA North Texas Health Care System (VANTHCS) in Dallas, TX is seeking to hire two RN's to fill the role of Utilization Management.

There is one position for Nights shift and one position for Days shift. Work Schedule for Nights Position (1 position available): 7:30pm to 8:00am.

Every other Weekend Off Work Schedule for Days Position (1 position available): 6:30am to 4pm or 7:30am to 5pm.

Education Debt Reduction Program (EDRP) is Authorized Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C.

7403(f), 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 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); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program.

Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program.

(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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program.

Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).

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.

Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and 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.

Preferred Experience: In-depth clinical knowledge and hands-on experience in nursing, preferably with a background in a variety of healthcare settings such as acute care, long-term care, and outpatient services.

Prior experience in utilization management or utilization review, including familiarity with health care reimbursement systems, insurance coverage policies, and criteria such as MCG (formerly Milliman Care Guidelines), InterQual, or other evidence-based criteria used in determining medical necessity.

Strong analytical and critical thinking skills to analyze and interpret clinical information, assess the appropriateness of care, and make evidence-based decisions.

Excellent verbal and written communication skills to effectively interact with healthcare providers, patients, and insurance representatives.

Ability to clearly articulate review findings and recommendations.

Thorough understanding of healthcare regulations and compliance, including CMS guidelines, HIPAA regulations, and other relevant federal and state laws affecting healthcare delivery and reimbursement.

Strong problem-solving skills to address complex clinical cases, manage resource utilization, and collaborate with interdisciplinary teams to optimize patient care and cost-efficiency.

Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade.

The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12902638.

Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.

An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.

Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.

An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.

Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations.

An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience.

Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.

A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience.

Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.

MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

*Note: Foreign education programs/degrees are not creditable as related degrees.

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: Moderate lifting, 15-44 pounds; Moderate carrying, 15-44 pounds; Straight pulling (8-12 hours); Pushing (8-12 hours); Reaching above shoulder; Both hands required; Walking (8-12 hours); Standing (8-12 hours); Kneeling (8-12 hours); Repeated bending (8-12 hours); Climbing, legs only (8-12 hours); Both legs required; Near vision correctable at 13" to 16" to Jaeger 1 to 4; Far vision correctable in one eye to 20/20 and to 20/40 in the other; Depth perception; Ability to distinguish basic colors; Ability to distinguish shades of colors; Hearing (aid may be permitted); Twisting; Grasp; Fine Manipulation.

Major Duties:

The staff nurse in Utilization Management is a registered nurse, qualified by education and experience, responsible for assessing the appropriateness of admission and continued stay for billable and non-billable inpatient cases, screening of outpatient services.

The UM nurse provides leadership for and participates in performance improvement activities.

He/she must possess the ability to interact with a wide variety of employees and to work independently in accomplishing assignments and program goals.

The UM nurse will work in collaboration with clinical and administrative staff that are engaged in access and patient flow.

The UM nurse functions within established guidelines and demonstrates the ability to work effectively and develop sound relationships with patients, their caregivers, and other professional and supportive personnel who provide patient care.

He/she must be willing to work onsite as needed and directed by the Utilization Management Nurse Manager. He/she will be willing to participate in on site training and system Redesign Projects.

Duties include, but are not limited to the following: Accountable for accurate and complete data collection as it relates to these responsibilities Possesses intimate knowledge of InterQual review criteria, utilization management processes and principles, clinical documentation requirements, current standards of care, and compliance guidelines.

Utilizes critical thinking skills and sound judgement to ensure positive outcomes, maximize effective hospital resource utilization, while ensuring quality patient care services Performs regular review of charts and other documents, ensures that the admission and continued stay review process follow utilization review guidelines and VHA Directive and review process.

Participates in discussion with medical and nursing staff in reviewing length of stay and discharge criteria Demonstrates excellent interpersonal relationship skills in interpreting and communicating service and hospital goals, objectives, policies and procedures to staff, patients and healthcare team members.

Participates in daily patient Huddles/Flow meeting to assure that the patient is at the appropriate level of care and will provide concurrent feedback to the patient's providers regarding potential alternatives to care.

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 for Nights Position (1 position available): 7:30pm to 8:00am.

Every other Weekend Off Work Schedule for Days Position (1 position available): 6:30am to 4pm or 7:30am to 5pm. Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not authorized Education Debt Reduction Program (EDRP) - Authorized: This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program.

You must meet specific eligibility requirements per VHA policy and submit your EDRP application within four months of appointment.

Program Approval, award amount (up to $200,000) & eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application.

EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact vhaedrpprogramsupport@va.gov, the EDRP Coordinator for questions/assistance.

Learn more Permanent Change of Station (PCS): Not authorized