Registered Nurse - Utilization Management
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 come in and out of the facility when needed to train others as needed. He/she will be willing to participate in system Redesign Projects. The Utilization Management RN:
is 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 is accountable for utilizing 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. May be allowed to participate in telework and on-site work as deemed necessary by the organization. Work Schedule:
Monday thru Friday, 6:
30am to 4pm or 7:
30am to 5pm Financial Disclosure Report:
Not required Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. 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. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 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 Preferred Minimum of 2 years' experience in Utilization Management UM/UR Certification One or more years' experience using McKeeson InterQual Criteria Guide 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:
Moderate lifting; 15-44 pounds; Moderate carrying; 15-44 pounds; Reaching above shoulder; Use of fingers; Both hands required; Walking (8-12 hours); Standing (8-12 hours); 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; Both eyes required; Ability to distinguish basic colors; Hearing (aid permitted).
Estimated Salary: $20 to $28 per hour based on qualifications.
is 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 is accountable for utilizing 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. May be allowed to participate in telework and on-site work as deemed necessary by the organization. Work Schedule:
Monday thru Friday, 6:
30am to 4pm or 7:
30am to 5pm Financial Disclosure Report:
Not required Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. 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. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 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 Preferred Minimum of 2 years' experience in Utilization Management UM/UR Certification One or more years' experience using McKeeson InterQual Criteria Guide 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:
Moderate lifting; 15-44 pounds; Moderate carrying; 15-44 pounds; Reaching above shoulder; Use of fingers; Both hands required; Walking (8-12 hours); Standing (8-12 hours); 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; Both eyes required; Ability to distinguish basic colors; Hearing (aid permitted).
- Department:
0610 Nurse - Salary Range:
$56,330 to $130,541 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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