Registered Nurse - Utilization Management
CLINICAL Uses nursing diagnoses, orders, lab values, progress notes, treatment plans, and discharge summaries to be able to discuss the appropriateness and effectiveness of health care provided by all health care professionals. Assesses the clinical content of medical records and associated documentation for quality and appropriateness of clinical care such as adherence to or deviation from accepted practice standards, guidelines, and/or procedures. Uses clinical knowledge and professional judgment to apply UM criteria in the evaluation of appropriate level of care provided to patients. Analyzes interprets and trends utilization review data and communicates findings to leadership, clinical services and appropriate committees. Utilizes UM data to drive organizational change related to patient flow and the development of efficiencies in patient care delivery. Teaches clinical staff how to use interQual criteria to evaluate appropriateness of care. Organizes, leads, and/or participates in interdisciplinary meetings of clinical and/or non-clinical staff where patient flow improvement plans are developed and implemented. ADMINISTRATIVE Advises Chief, Quality Management and senior leaders of significant potential or actual problems related to health care delivery and organization-wide compliance with utilization management standards. Works with management to develop, implement and/or revise a utilization management plan to promote optimal bed management and patient flow within the organization. Recommends modification to the utilization management plan as necessary to optimize bed management and patient flow. Collaborates with senior leaders and clinical and administrative staff to initiate changes in practice based on findings from UM and QM activities. Advises Chief, Quality Management and senior leaders of significant potential or actual problems related to health care delivery and organization-wide compliance with utilization management standards. Assists Chief, Quality Management Service in policy review, formulation, communication, implementation, evaluation and establishing facility priorities related to utilization management and/or quality management activities. Assists in the review and evaluation of data to determine the presence or absence of trends and patterns that indicate opportunities for improvement. Undertakes special projects related to improving the quality of care. Provides guidance and technical assistance to staff. Work Schedule:
Monday through Friday from 3:
00 PM to 11:
30PM Financial Disclosure Report:
Not required This position is eligible for the Education Debt Reduction Program (EDRP), a student loan reimbursement program within VHA. If selected for this position you must meet specific individual eligibility criteria in accordance with VHA policy 1021 and apply for EDRP within four (4) months of appointment. Final award amount and program start date is determined after review of a complete EDRP application and supporting documentation by the VHA Education Loan Repayment Services office. If selected for this position, please contact (local coordinator contact information). This position is eligible for telework, however, it is not a remote position. The employee will be required to physically report to the workplace routinely. 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. 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. BLS Certification Preferred Criteria:
BSN RN with five years of professional nursing 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 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's 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 year's of nursing practice/experience; OR a Doctoral degree and approximately 2-3 year's of nursing practice/experience. 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:
This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued 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.
Estimated Salary: $20 to $28 per hour based on qualifications.
Monday through Friday from 3:
00 PM to 11:
30PM Financial Disclosure Report:
Not required This position is eligible for the Education Debt Reduction Program (EDRP), a student loan reimbursement program within VHA. If selected for this position you must meet specific individual eligibility criteria in accordance with VHA policy 1021 and apply for EDRP within four (4) months of appointment. Final award amount and program start date is determined after review of a complete EDRP application and supporting documentation by the VHA Education Loan Repayment Services office. If selected for this position, please contact (local coordinator contact information). This position is eligible for telework, however, it is not a remote position. The employee will be required to physically report to the workplace routinely. 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. 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. BLS Certification Preferred Criteria:
BSN RN with five years of professional nursing 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 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's 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 year's of nursing practice/experience; OR a Doctoral degree and approximately 2-3 year's of nursing practice/experience. 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:
This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued 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.
- Department:
0610 Nurse - Salary Range:
$74,961 to $133,665 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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