Registered Nurse - Utilization Management

About the role

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

Responsibilities

• Collects, analyzes, and reports data
• Creates and provides provider education to a variety of providers
• Collaborates on ordered level of care and treatment plans
• Conducts InterQual reviews on prospective, observation, admission, and continued stay patients
• Activities include implementing and managing the UM Program and applying NUMI software for clinical screening, data aggregation, and reporting
• Creates and provides education and guidance to internal and external customers on admission and continued stay criteria and best clinical documentation and utilization management practices
• Affords assistance in directing the provision of nursing education, orientation, competencies, and quality improvement and outcomes utilization consultation
• Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others on the acute care team
• Displays proficiency in decision-making and using the nursing process for complex situations that affect performance outcomes at the point of care
• Enhances practice through development of collegial relationships
• Displays collaboration by using the group process to solve problems and impact Veterans in acute care
• Displays critical thinking with efficiency and accuracy in assessing and managing situations

Requirements

• Basic English Language Proficiency
• Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by ACEN or CCNE
• Current - full - active - and unrestricted registration as a graduate professional nurse in a State - Territory or Commonwealth of the United States - or the District of Columbia
• Bachelor of Science in Nursing (BSN) or Master's degree in nursing (MSN)
• Master's degree in a related field with a BSN
• Doctoral degree in Nursing or a related field with a BSN

Qualifications

• Basic education requirements met
• Positive education and licensure/certification
• Grade and level applicable to 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)
• 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
• Scope - Education and Dimension criteria must be met in determining the grade assignment of candidates
• 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

Skills

• Decision-making
• Nursing process
• Collaboration
• Leadership
• Quality improvement

Benefits

• Competitive salary
• Regular salary increases
• Potential for performance awards
• 50 days of paid time off per year (26 days of annual leave - 13 days of sick leave - 11 paid Federal holidays per year)
• Traditional federal pension (5 years vesting)
• Federal 401K with up to 5% in contributions by VA
• Insurance: Federal health/vision/dental/term life/long-term care

Pay

Competitive salary - regular salary increases - potential for performance awards

Schedule

M-F - 7:00AM - 3:30 PM