The Registered Nurse Utilization Management executes position responsibilities that demonstrates leadership, experience, and creative approaches to management of complex patient care. The registered nurse (RN) is an EXPERT nurse, "with an enormous background of experience, who now has an intuitive grasp of each situation and zeros in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions" (Benner).

Duties

The Registered Nurse Utilization Management demonstrates performance and leadership that is broad and complex enough to improve the care for a group of patients. The Nurse is responsible for the documented outcomes at the program or service level. Nurse Ill is responsible for a substantial coordinated group of activities that affect service and organizational level outcomes that are broad and complex and can be demonstrated at any organizational level within the facility, VISN, or VACO. Nurse Ill demonstrates (a) Leading and organizing delivery of care to assure continuity of care and peer accountability for practice, including access to care and discharge planning; (b) Using advanced clinical knowledge and judgment to promote staff involvement in planning, decision-making, and evaluating outcomes, (c) Functioning as an expert in practice and/or areas related to the assigned roles and responsibilities, (d) Systematically evaluating current practice, and formulating outcomes for groups of patients and organizational processes within an area of expertise, (e) Guiding, developing, and supporting staff from a leadership perspective, and (f) Using professional standards of care, scientific evidence, and practice to evaluate programs and service activities. Duties: Shares the responsibility for the overall planning, implementation, and evaluation of both Effectively communicates with physicians, nurses, and other health care providers in obtaining or verifying data for review and formulating a plan of care. Demonstrates a thorough knowledge of medical records and can retrieve pertinent information from multiple sources for case review. Serves as the expert using standardized criteria (i.e., InterQual) to conduct clinical reviews for appropriateness of admission, continued stays, high-cost imaging, and other relevant resource intensive services. Conducts prospective reviews on high-cost imaging services (i.e., CT, MRI) in accordance with medical imaging standardized criteria (i.e., InterQual), UM processes and principles, clinical documentation requirements, current standards of care, and compliance guidelines. Serves as a liaison with the clinical staff to facilitate quality of care that is cost-effective and identifies organizational barriers and recommends improvements. Utilizes specialized expertise to assess, design, measure and evaluate broad programs or clinical practice and coordinate Utilization Review (UR) activities in assigned areas. Provides leadership in application of the nursing process and identifies resources and critical factors for achieving desired outcomes for discharge, post hospitalization. recovery and health maintenance and improvement. Meets with inpatient team to discuss continued stay criteria. Uses principles of performance improvement, risk management, patient safety and UR to identify system issues that impact on patient care delivery and makes recommendations for improvement. Initiates and actively participates in interdisciplinary quality improvement teams and committees to collect, analyze, and evaluate data, implement change, and evaluate effectiveness of the change results. Recommends process changes to improve and evaluate outcomes. Preferred Qualifications: Quality related certifications to include but not limited to Certified Professional in Healthcare Quality, Certified InterQual instructor, Certified Professional in Patient Safety, and Lean Six Sigma or other process improvement certifications (Yellow, Green, or Black Belt). Experience in Utilization Management/Utilization Review, InterQual or Milliman, and Microsoft Excel. 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 Day hours Telework: Not 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: Quality related certifications to include but not limited to Certified Professional in Healthcare Quality, Certified InterQual instructor, Certified Professional in Patient Safety, and Lean Six Sigma or other process improvement certifications (Yellow, Green, or Black Belt). Experience in Utilization Management/Utilization Review, InterQual or Milliman, and Microsoft Excel. 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: All applicants must be physically and mentally able to perform efficiently the duties of the position. Must be able to lift (30 lbs or more); twisting and/or bending, standing. 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,

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 Tennessee Valley HCS - Nashville 1310 24th Avenue South Nashville, TN 37212 US
• Name: Margaret Blunt
• Phone: 615-592-6495
• Email: [email protected]