Registered Nurse Utilization Management Case Manager

Utilization Management Registered Nurse

The Utilization Management (UM) Registered Nurse duties and responsibilities include, but are not limited to, the following:

• Perform admission continued stay, and concurrent utilization review using evidence-based criteria such as InterQaul
• Determine appropriate patient status (inpatient, observation, outpatient) based on medical necessity
• Collaborate with physicians and physician advisors regarding level of care determinations
• Identify avoidable delays and barriers affecting length of stay
• Participate in interdisciplinary daily huddle to support patient flow and discharge planning
• Assist with prolonged stays for timely intervention
• Provide cross-coverage for the Inpatient case management responsibilities as needed

Preferred Experience: Minimum 3 years of acute care nursing experience required; Prior case management, utilization review, or discharge planning experience preferred; Knowledge of Medicare, Medical, and 3rd party insurance; Strong clinical judgment and critical thinking skills; and Excellent communication & interdisciplinary collaboration abilities 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, Saturday Rotation

Telework: Not Available

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not Available

Permanent Change of Station (PCS): Not Authorized