Utilization Management Registered Nurse

Department of Veterans Affairs

Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. Assesses, plans, implements, and evaluates care based on age-specific components. Assumes responsibility for assessing medical necessity and appropriateness of level of care, healthcare services, procedures and treatments for patients in the acute care setting using National Utilization Management Integration (NUMI), a web based application.

• The 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 reviews on prospective, observation, admission, and continued stay patients Major duties include, but are not limited to: Reviews admissions and daily continued stays for the following inpatient and treating specialties, medicine, surgery, and behavioral health. Identifies the appropriateness of the level of care and services. Provides initial screening and ongoing assessment of patients in the Emergency Department, Medical Services, Surgery Services, and Psychiatry Services, as well as those identified as transfers and direct admissions to facilitate appropriate UM review. Identifies resources and critical factors for achieving desired outcomes for admission criteria or discharge, post hospitalization recovery and health maintenance/improvement. Provides information to assist with decision-making related to the patient care management and discharge coordination. Tracks and trends issues related to care delivery and participates in utilization review and quality improvement activities to identify areas of improvement. Performs and documents utilization reviews consistent with national guidance. Communicates with Physician Utilization Management Advisor (PUMA) as necessary Collaborates with the multidisciplinary team in planning, directing, and implementing patient care. Demonstrates ability to exercise critical thinking, problem solving and collaborative skills in a high stress environment. Participates in Utilization Management performance improvement initiatives designed to improve quality, patient flow, resource utilization, throughput, access to care, and length of stay. Participates in facility, VISN, and national discussions related to utilization management performance measures, regulatory requirements, patient flow initiatives, resource utilization, and quality outcomes assigned. Participates in System Redesign, Lean, HRO, and performance improvement activities designed to improve efficiency, effectiveness, and quality of care. Identifies, escalates, and assists in resolving barriers impacting appropriate utilization of resources, timely transitions of care, discharge readiness, and access to services. Successfully completes comprehensive training in PMDB Verbal Interventions and Personal Safety Skills, including hands-on training. The incumbent is fully trained to immediately implement patient containment safety procedures and can effectively apply all learning from all levels of PMDB training, including de-escalation techniques, into practice. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday - Friday 7:00am - 3:30pm Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

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