The South Texas VA Healthcare System is seeking a experienced Registered Nurse to fill the role of Lead Utilization Management (UM), responsible for overseeing and coordinating utilization management activities within the healthcare facility.

Duties

The Lead Utilization Management (UM) Registered Nurse (RN) at the VA Hospital is responsible for overseeing and coordinating the utilization management activities within the healthcare facility. The Lead UM RN at the VA Hospital plays a vital role in optimizing resource utilization while ensuring high-quality, patient-centered care. This position requires strong clinical knowledge, leadership skills, and the ability to collaborate effectively with various healthcare professionals to achieve efficient and effective utilization management outcomes. The UM RN reports to the Nurse Manager for Planning, Performance and Development (P2D): Utilization Management Oversight: The Lead UM RN takes a leadership role in monitoring and managing the utilization management processes, including reviewing medical records, coordinating with healthcare teams, and ensuring compliance with utilization management guidelines and regulatory requirements. Clinical Review and Decision Making: Conducting comprehensive clinical reviews of patient medical records, analyzing data, and making evidence-based decisions regarding appropriateness of care, level of care, and resource utilization. This includes reviewing medical necessity, length of stay, and discharge planning to ensure the optimal use of healthcare resources. Team Leadership: Providing guidance, support, and supervision to the UM RNs and other staff members involved in utilization management activities. This includes training, performance evaluation, and fostering a collaborative team environment. Collaboration and Communication: Collaborating with interdisciplinary teams, such as physicians, nurses, case managers, and administrators, to ensure effective communication, coordination, and resolution of utilization management issues. This includes participation in rounds, meetings, and committees related to utilization management and care coordination. Policy Development and Implementation: Assisting in the development, implementation, and evaluation of utilization management policies, procedures, and protocols. Staying updated with regulatory changes and industry best practices to ensure compliance and promote continuous quality improvement in utilization management processes. Education and Training: Providing education and training to healthcare professionals, including UM staff, regarding utilization management principles, guidelines, and processes. This includes conducting training sessions, developing educational materials, and promoting awareness of utilization management principles across the organization. Quality Improvement: Actively participating in quality improvement initiatives related to utilization management, such as data analysis, performance monitoring, and identification of opportunities for improvement. Collaborating with stakeholders to implement evidence-based practices that enhance patient outcomes and resource utilization. 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 thru Friday; 8:00 am to 4:30 pm Telework: Available based on facility policy 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

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 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: Able to communicate effectively with internal and external customers 3-5 years recent Clinical Experience 2-5 years recent Interqual Experience Ability to analyze and compile data 2-3 years experience managing teams and/or programs 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: The population of male and female Veterans served ranges from the adult, age 18, to the elderly adult, age 65 and over. South Texas Veterans Health Care System is a tertiary healthcare facility, providing acute medical, surgical, behavioral health, physical medicine and rehabilitation, geriatric, and primary care services predominately to Veterans, but in special cases, includes active-duty military and civilian populations. This position requires visual acuity, hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. Refer to Optional Form 178 dated April 2012 for additional functional requirements and environmental factors. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent may be exposed to infectious patients and/or contaminated materials that my require wearing of various levels of personal protective equipment (PPE) for long periods of time, caring for patients on isolation precautions, active participation in screening potentially infectious patients, and participating in labor pools during pandemics/disaster response situations the incumbent may be required to work in modified environments of care based on safety requirements and the needs of the patient. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, and be able to shift priorities based on patient needs.

Education

Note: Only education or degrees recognized by the appropriate State agency and accredited by either: a) The Accreditation Commission for Education in Nursing (ACEN); or b) The Commission on Collegiate Nursing Education (CCNE) or 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:

1. ACEN - http://www.acenursing.us/accreditedprograms/programSearch.htm
2. CCNE - https://www.aacnnursing.org/CCNE-Accreditation/CCNE-Accredited-Programs
3. U.S. Department of Education - 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.

Note: If your school was accredited by Accreditation Commission for Education in Nursing (ACEN) or Commission on Collegiate Nursing Education (CCNE) at the time of graduation but is no longer listed on the ACEN or CCNE website, you must provide documentation of accreditation with your application packet.

Note: If your school has changed names, or is no longer in existence, you must provide this information in your application.

Note: Failure to submit supporting documentation may disqualify you for further consideration on this announcement.

Contacts

• Address Audie L Murphy Memorial Veterans Hospital 7400 Merton Minter Boulevard San Antonio, TX 78229 US
• Name: VISN 17 SSU USAS Group
• Email: [email protected]