You will establish work priorities to accomplish Utilization Management assignments timely. Demonstrates proficiency in advanced and highly technical skills necessary for the Utilization Management Program, specifically related to documentation review for accuracy of codes, diagnoses, procedures and care of patients.

Duties

As the Utilization Management Clinician you will collect patient data using different modalities including interview and systematic review of records. Complete and document applicable Nursing Notes in the electronic health record in a timely manner and closes encounters by the end of tour of duty daily. Utilizes MOU standards or VHA approved decision support tool for LTAC and IRU to facilitate appropriate care and ensure ideal utilization of resources. Consult with PUMA, PM&R or designee when a veteran does not meet criteria. Initiate, provide, maintain, and analyze accurate documentation and databases. Notify appropriate service when problems or issues occur. Work collaboratively with VA Health Administration Service and refers questions about fee and eligibility to appropriate staff such as HBA, VSOs, etc. Facilitate discharge planning in consultation with the physician, patient, family, and appropriate health care team members. Work with the hospital/facility case managers or social worker and VHA social work to facilitate discharge planning. Demonstrate the ability to communicate through role modeling and instruction of positive communication skills to promote an environment of acceptance, openness and feedback. Recognize the need for assistance, clinical and administrative, and request assistance as appropriate. Maintain collegial working relationship with professionals and support personnel within or outside of the service. Promote health promotion and risk reduction strategies. Demonstrate knowledge of policies, procedures and standards of care to promote evidence-based patient-driven care. Ensure completion of continued stay reviews in a timely manner (every 2-3 business days). Complete mandatory on-line in-service education programs and staff development by due date. Improve quality of care coordination between VA and external hospitals. Address authorization corrections within Tri-West and HSRM. Provide excellent customer service. Use the nursing process and evidence-based practice to collaborate with the Teamlet, extended Team and external members (community-based services involved in providing care to the patient) to meet patient needs. Demonstrate advanced clinical knowledge in assessing, planning, implementing, documenting and evaluating care for a designated group of patients across the continuum of care. Provide timely notification of hospital discharges to the High Risk Care Management team and PACT. Function as a systems coordinator, monitor progress and intervene as necessary to ensure that patient outcomes are achieved within anticipated timeframes. Monitor progress along clinical pathways, analyze variations and initiate appropriate actions. Advocate fiscal responsibility in the management of patient care through effective utilization of resources. Maintain privacy and confidentiality of all information, including electronic, print and conversations. Promote use of warm hand-off communication for care coordination to other levels of care (multidisciplinary) resources. Collect and update database documentation on a daily, weekly and monthly timeline. Assist with staff orientation and precepting. Participate in activities for personal growth and development. 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: Full-time; Monday-Friday; 8:00am-4:30pm Telework: Available; 6+ days per pay period Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required Bargaining Unit: This is a bargaining unit position.

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. HPTs who are on track to graduate/complete the requirements should respond as if they have met the requirements. Provide details in the narrative sections of the assessment. 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: -2-3 years Case Management experience -2-3 years Discharge planning -InterQual proficient - LTAC / Rehab 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 position requires moderate lifting and carrying (15-44 pounds), straight pulling (0.5 hours), pushing (0.5 hours), reaching above shoulder, walking (5.3 hours), standing (5.3 hours), repeated bending (5.3 hours), ability for rapid mental and muscular coordination simultaneously, 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, depth perception, ability to distinguish basic colors, and hearing (aid permitted).

Education

The Associate Degree Nursing (ADN), Bachelor of Science degree in Nursing (BSN), or Master of Science degree in Nursing (MSN) must be fully accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission On Collegiate Nursing Education (CCNE). Verification of accreditation may be obtained from http://www.acenursing.us/accreditedprograms/programsearch.htm or https://directory.ccnecommunity.org/reports/accprog.asp

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

If your school was accredited by ACEN or CCNE at the time of graduation, but is no longer listed on the websites, you must provide documentation of accreditation with your application packet.

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.

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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address VA TX Valley Coastal Bend HCS 2601 Veterans Drive Harlingen, TX 78550 US
• Name: VISN 17 SSU USAS Group
• Email: [email protected]