This position falls under the Associate Chief of Staff, Clinical Operations.

Duties

The Utilization Management Nurse Reviewer is a generalist and reports directly to the Nurse Manger, Utilization Management under the auspice of the Associate Chief of Staff, Clinical Operations. The Utilization Nurse Reviewer functions within the assigned area and is responsible and accountable for the coordination and efficiency of care for a culturally diverse adult and geriatric veteran population. Reviewing Observation levels of care and monitoring daily to determine medical appropriateness for discharge or Inpatient conversions. Reviewing hospital admission and continued stay reviews to ensure appropriate status and level of care (maintaining minimum 80% completion monthly); using established InterQual screening criteria to review and determine medical appropriateness of all hospital Completing admission and continued stay reviews in the National Utilization Management Integration (NUMI) software. Communicates with physician's offices, Emergency Department, Outpatient surgery and ancillary departments to facilitate assignment of most appropriate patient status and level of care as needed for transfers and bed placement. Communicates as needed with the Admitting Physician, the severity and intensity of illness and the treatment plan of the patient for determination of most appropriate level of care. Communicates with Bed Flow Coordinator and clinical care team to collaboratively achieve effective and efficient admission processes; Working closely with MAS to improve throughput. This position will have responsibility for reviewing patient care documentation within the medical chart conducted onsite and ad-hoc telework using InterQual. The Nurse II, Utilization Management Nurse Reviewer may serve on committees, workgroups, and teams as assigned by management. The Utilization Management Nurse Reviewer maintains InterQual competency by attending yearly training and conducting Inter-Rater Reliability (IRR)reviews as assigned; ensuring all measures are met in accordance with regulations and governing body guidelines. Additionally, the Nurse II, Utilization Management Nurse Reviewer will cross cover and complete patient reviews for Observation and Inpatient levels of care; attend daily huddles, meetings, and other duties as assigned. Other duties as assigned (i.e., weekend reviews and retro-reviews) 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 7:30am - 4:00pm Telework: Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required

Requirements

Qualifications

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 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). The approving official may authorize a waiver of the requirement for ACEN or CCNE accreditation of any degree in nursing provided the college or university has regional accreditation from an accrediting body recognized by the Department of Education at the time of the candidate's graduation and the composite qualifications of the applicant warrant such consideration. 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: 2 years of Case Management experience, 2 years of InterQual experience, 2 years of Utilization Management (UM) experience 5 years total RN 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 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years 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 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. 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 pounds and over; Heavy carrying 45 pounds and over Straight pulling (1-2 hrs); Pushing (1-2 hrs) Reaching above shoulder (1-2 hrs); Kneeling; Repeated bending (1-2 hrs) Walking (2-4 hrs); Standing (2-6 hrs) Use of fingers; Use of both hands Near vision correctable; Far vision correctable Depth perception; Hearing (aide permitted) Ability for rapid mental and muscular coordination simultaneously Work closely with others, as well as, protracted or irregular hours of work

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address New Orleans VA Medical Center 2400 Canal Street New Orleans, LA 70119 US
• Name: Rena Hairston
• Phone: 504-521-9608
• Email: [email protected]