RN Utilization Management
The registered nurse 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, care coordination. The nurse is responsible for applying clinical skills in reviewing, assessing and evaluating patient care processes for appropriateness of care across the continuum of care. The UM nurse effectively communicates with physician, nurses and other health care providers in obtaining and verifying data for review and formulating a plan of care. The UM nurse has a thorough knowledge of the patient's medical records and can retrieve pertinent information from multiple sources/packages for case review (I.e. CPRS, VistA, Outlook, NUMI). Performs utilization review and certifies patient stay by analyzing patient medical records and accompanying physician documentation. Performs concurrent reviews for proper patient classification and ongoing need for hospitalization, using appropriate criteria. Utilizes knowledge of medical necessity and appropriateness of setting gained through a thorough understanding of evidenced based criteria (lnterqual). Conducts concurrent utilization review, applies criteria to all observation, inpatient admissions and extended stay reviews, meeting all timeframes in order to insure timely communication with physicians. Participates in scheduled committees presenting UM review findings related to level of care discrepancies, quality of care issues or delay in care according to approved local policies. Daily participation in organizational meetings. Demonstrates effective application of knowledge of VA and external rules (e.g., HCFA), regulations, standards, etc. in carrying out the UM function. Other duties as assigned including clinical reviews and performance improvement activities. Work Schedule:
Monday - Friday, 7:
30 a.m. 4:
00 p.m., excluding weekends and Federal holidays Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/02/2020. 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. Preferred
Experience:
BSN with Utilization Management 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:
Heavy lifting (45 lbs and over); Moderate Lifting (15 - 44 lbs); Light Lifting (under 15 lbs); Heavy Carrying (45 lbs and over); Moderate Carrying (15 - 44 lbs); Light Carrying (under 15 lbs); Pushing (up to 2 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (up to 5 hours); Standing (up to 3 hours); Repeated bending (up to 2 hours); Ability for rapid mental and muscular coordination simultaneously; Depth perception; Ability to distinguish basic colors; Hearing (aid permitted).
Estimated Salary: $20 to $28 per hour based on qualifications.
Monday - Friday, 7:
30 a.m. 4:
00 p.m., excluding weekends and Federal holidays Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/02/2020. 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. Preferred
Experience:
BSN with Utilization Management 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:
Heavy lifting (45 lbs and over); Moderate Lifting (15 - 44 lbs); Light Lifting (under 15 lbs); Heavy Carrying (45 lbs and over); Moderate Carrying (15 - 44 lbs); Light Carrying (under 15 lbs); Pushing (up to 2 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (up to 5 hours); Standing (up to 3 hours); Repeated bending (up to 2 hours); Ability for rapid mental and muscular coordination simultaneously; Depth perception; Ability to distinguish basic colors; Hearing (aid permitted).
- Department:
0610 Nurse - Salary Range:
$52,544 to $106,189 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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