The Utilization Management (UM) Nurse Manager (NM) is a registered professional nurse responsible for the assessment, planning, provision and evaluation of UM Program. The UM NM serves as a role model, educator, practitioner, and manager-providing leadership to the UM RN team. The UM NM executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client cases as it relates to the practice of utilization management.

Duties

The Utilization Management (UM) Nurse Manager (NM) is the co-chair of the UM Committee and shares responsibility with the Lead Physician Utilization Management Advisor (PUMA) co-chair for the administration of the activities and decisions of the UM Committee, which reports up to the Inpatient Steering Committee and the Quality Board. The UM NM is directly supervised by the Chief of Quality and Patient Safety (QPS), who provides the administrative supervision and general instruction, oversees, and evaluates work product, approves leave and completes performance evaluations. The duties and recommendations of the UM NM can lead to changes in organizational structures, staffing levels and assignments, and policy. This is a non-bargaining unit position. The UM NM is qualified by education and experience to provide direct staff support to Senior Leadership, Service Line Leaders, and others in the planning, designing, integrating, implementing, modifying, and evaluating the effectiveness of program components and/or services to improve the quality of patient care and the appropriateness and timeliness of services provided. Recommendations from the UM Manager on the cost effectiveness and efficiency of programs have a directly impact on policy and alignment of resources, including staffing. The UM NM will independently supervise the UM personnel in section, service line, and facility utilization management activities. This responsibility includes development of performance standards, writing functional statements and position descriptions, evaluating work performance, counseling of employees whose performance is marginal or unsatisfactory, initiating disciplinary actions when necessary. Hears and resolves complaints from employees. The UM NM makes program and facility specific decisions that reflect the distinct and contributory role of nursing; is responsible for providing clinical and administrative recommendations relative to programs, committees, and/or services that relate to Utilization Management; and is a member of the team involved in Performance Improvement (PI), as an approach to assess and improve the quality of healthcare services, including utilization of resources. The UM Nurse conducts analyses of the cost/value of clinics and programs, which can lead to recommendations that affect the distribution of resources, include staffing levels and assignment, and the use of fee or contract employees. The UM NM will serve as the NUMI Administrator. Designated first-line supervisory authority, responsibility, and accountability for Utilization Management Program, ensuring that subordinate personnel provide timely review which complies with generally accepted standards of practice. This includes the all the following functions: 1) Planning work to be accomplished by subordinates, setting priorities, and preparing schedules for completion of work 2) Assigning work to subordinates based on priorities, selective consideration of the difficulty and the requirements of the assignments, and the capabilities of subordinates 3) Evaluating the performance of subordinates. 4) Giving advice, counsel, or instruction to subordinate personnel on work and administrative matters 5) Hearing and resolving complaints of subordinates and referring more serious complaints not resolved to higher level supervisors 6) Recommending and/or taking disciplinary action where appropriate 7) Identifying developmental and training needs of subordinates and providing or making provision for such development and training (VA Handbook 5007, Part III, Chapter 8). 8) Performs other duties as assigned to meet the needs of the Quality and Patient Safety Service, Veterans, and the organization. Responsible for performance improvement data, patient, and employee safety, interviewing applicants, employee relations, standards of care and practice, the work environment, and accreditation and regulatory standards. 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-hour variable shifts between 7:00 am and 6:30 pm Travel: 25% or Less Compressed/Flexible: Not Available Telework: Not Authorized 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: English Language Proficiency. In accordance with 38 U.S.C. 7403(f), 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 the appropriate accrediting agency and accredited 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); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). 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. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12471472. Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies. An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required. Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex. An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required. Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience. Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience. Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting. MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III. *Note: Foreign education programs/degrees are not creditable as related degrees. 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. Preferred Experience: The UM NM will possess a bachelor's degree in nursing. A master's degree in nursing or in a field related is preferred. 2 to 3 years Utilization Management Experience Minimum 2 to 3 Years Nursing Leadership Previous Case Management and/or Discharge Management Experience Minimum 3 to 5 years recent successful nursing practice in acute inpatient medical/surgical setting Demonstrated experience in conducting, analyzing and documenting utilization management reviews, consistent with national guidance, to be entered as data into the National Utilization Management Integration. Physical Requirements: To perform in a fully successful manner, the individual must have the physical ability to perform job-related duties which require lifting, standing, bending, transferring, stooping, stretching, walking, pushing, or pulling without assistance from another patient care provider or significant other. A health examination must be successfully completed prior to this assignment and periodically thereafter as required by the Employee Health Clinic policy. There will be intermittent exposure to blood and body fluids.

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 Edward Hines Junior Hospital 5000 South 5th Avenue Hines, IL 60141 US
• Name: Irene Balas
• Phone: 708-640-4736
• Email: [email protected]