Registered Nurse - Utilization Management

Full Job Description

OUR MISSION: To fulfill President Lincoln's promise "To care for those who have served in our nation's military and for their families, caregivers, and survivors" - by serving and honoring the men and women who are America's Veterans.

How would you like to become a part of a team providing compassionate whole health care to Veterans? 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.

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/12884560.

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.

Preferred experience/certification: Utilization Management Experience, MSN, CPHQ Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Standards: Heavy lifting (up to 50 pounds); heavy carrying (up to 50 pounds); straight pulling (2-4 hours); pushing (2-4 hours); reaching above shoulders (1-2 hours); use of fingers; both hands required; walking (4-6 hours); standing (4-6 hours); repeated bending (2-4 hours); both legs required; ability for rapid mental and muscular coordination simultaneously; near vision correctable at 13" to 16" to Jaeger 1 to 4; far vision correctable in one eye to 20/20 and 20/40 in the other; both eyes required; ability to distinguish basic colors and shades of color; hearing aid (permitted); mental and emotional stability.

Major Duties:

Functions or Scope of Assigned Duties: Utilization Management Registered Nurse (RN) executes position responsibilities that demonstrate beginning leadership skills and participates in specific program experiences.

They demonstrate creative approaches to the management of aspects of complex patient care.

Care will be provided in the least restrictive, most cost-effective manner, through use of outpatient utilization management criteria, clinical practice guidelines and clinical pathways.

Assist with significant collaboration between community and Veterans Integrated Systems Network (VISN) healthcare personnel in the transition of veterans through the Veterans Affairs (VA) healthcare system.

They demonstrate performance and beginning leadership skills that start to impact the standard of care for all patients throughout the continuum of care.

They are responsible for completing services within the organization that meets the requirements of National Directives.

Provides quality and performance measures analysis and reporting of consult trends and systems issues through the utilization of the nursing process.

Responsible for the triage and care coordination of complex patients, works closely with Veterans to ensure smooth transition of care to community or VA facilities and care related to referrals, improvement meetings and service meetings.

They will collaborate with the interdisciplinary team to improve the delivery of patient care.

The consultant must be poised and articulate in communicating with all parties involved in the delivery of care, to include the Veteran, family, medical staff, community partners, etc.

Delegates elements of care to the appropriate individual based upon assessed needs, condition, and safety of the patient.

The nurse brings principles and theory with limited application of critical thinking skills.

Utilization Management (UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the position. Uses UM Criteria to perform complicated reviews.

The UM RN activities include collecting, analyzing, and reporting data, creating, and providing provider education to a variety of providers, collaborating on ordered level of care and treatments plans, and conducting lnterQual criteria reviews on prospective, observation, admission, and continued stay patients.

Responsible for creating and providing education and guidance to internal and external customers of varying education levels on admission and continued stay criteria and best clinical documentation and utilization management practices to ensure efficient resource utilization.

The individual will assist in directing the provision of nursing education, orientation, competencies and providing quality improvement and outcomes utilization consultation.

Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others on the acute care team.

The nurse is a proficient nurse who demonstrates proficiency in decision-making and using the nursing process for complex situations that affect performance outcomes at the point of care.

Practice is enhanced through development of collegial relationships. The nurse demonstrates collaboration by using the group process to solve problems and impact Veterans in acute care.

The focus is on leadership in strategically planning long-term goals for the UM microsystem that impacts operations or resources.

The proficient UM nurse demonstrates critical thinking with efficiency and accuracy in assessing and managing situations.

Utilization Management (UM) Registered Nurse (RN) reviewers will provide education to providers, analyzing, trending, and reporting data to leadership to identify opportunities for improvement of patient care and services in the Medical Center.

UM reviewers participate annually in inter-rater reliability assessments to measure consistency in the application and interpretation of standardized criteria.

The UM reviewer is the trained, licensed health care professional who performs UM reviews utilizing the NUMAC-approved, standardized, evidence- based criteria.

The role of the UM reviewer includes: Performing and documenting utilization reviews consistent with national guidance. Communicating with the health care team, including the attending physician.

Collaborating across services and departments to impact patient flow.

Participating in daily rounds on-site or virtually, bed huddles, or Interdisciplinary Team (IDT) care management meetings as appropriate.

Referring to the PUMA, those reviews that do not meet criteria but require medical leadership to facilitate resolution and referring to the PUMA any case that has quality of care issues or serious system issues needing immediate attention.

Work Schedule: Monday - Friday, 7:30 a.m. - 4:00 p.m. Telework: Not Authorized. Virtual: This is not a virtual position.