The VA South Texas Health Care System is seeking a Registered Nurse to serve in the Lead Utilization Management position in San Antonio, TX. 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.

Duties

The Lead Utilization Management (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 Lead Utilization Management 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 leadership 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. Work Schedule: Monday - Friday, 0800-1630 (Negotiable based on agency needs and supervisor approval) Telework: Ad-hoc may be available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized Bargaining Unit Status: This position is part of the bargaining unit. 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

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. Education: 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). License: 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. PREFERRED EXPERIENCE Experience communicating effectively with internal and external customers 3-5 years recent Clinical Experience 2-5 years recent Interqual Experience Experience analyzing and compiling data 2-3 years experience managing teams and/or programs 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/12499590. 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: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Physical Requirements: Moderate lifting, 15-44 pounds; Light lifting, under 15 pounds; Moderate carrying, 15-44 pounds; Straight pulling (1 hour); Pushing (1-3 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (4 hours); Standing (2-7 hours); Kneeling (2 hours); Repeated bending (2 hours); Climbing, use of legs and arms; Both legs required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16" to Jaeger 1 to 4; Vision 20/40 DVA, Corrected; Both eyes required; Ability to distinguish basic colors; Hearing (aid may be permitted); Sitting (8 hours); Simple grasping (2-4 hours); Fine manipulation (including keyboarding 4-6 hours); Twisting (2 hours); Mental and emotional stability.

Education

EDUCATION ACCREDITATION: The Associate Degree in Nursing (ADN), Bachelor of Science degree in Nursing (BSN), or Master of Science Degree in Nursing (MSN) must be recognized by the appropriate State-accrediting agency and accredited by either of the following accrediting agencies at the time the program was completed by the applicant:

1. The Accreditation Commission for Education in Nursing (ACEN) OR
2. The Commission on Collegiate Nursing Education (CCNE)
3. ACEN or CCNE program or degree accreditation may also be found under the U.S. Department of Education

NOTES:

• Department of Education: 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/.
• Foreign Education: 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.
• School Name: If your school has changed names, or is no longer in existence, you must provide this information in your application.
• No longer on accreditation site: 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

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]