Utilization Management Nurse Reviewer

Utilization Nurse Reviewer

The Utilization Nurse Reviewer functions within the assigned area and is responsible and accountable for the coordination and efficiency of care for a culturally diverse adult and geriatric veteran population. The Utilization Management Nurse Reviewer is a generalist and reports directly to the Nurse Manager, Utilization Management under the auspices of the Associate Chief of Staff, Clinical Operations.

Responsibilities include:

• Reviewing hospital admission and continued stay reviews to ensure appropriate status and level of care (maintaining minimum 80% completion monthly); using established InterQual screening criteria to review and determine medical appropriateness of all hospital.
• Completing admission and continued stay reviews in the National Utilization Management Integration (NUMI) software.
• Communicating with physician's offices, Emergency Department, Outpatient surgery and ancillary departments to facilitate assignment of most appropriate patient status and level of care as needed for transfers and bed placement.
• The Utilization Management Nurse Reviewer maintains InterQual competency by attending yearly training and conducting Inter-Rater Reliability (IRR) reviews as assigned; ensuring all measures are met in accordance with regulations and governing body guidelines. Additionally, Utilization Management Nurse Reviewer will cross cover and complete patient reviews for Observation and Inpatient levels of care; attend daily huddles, meetings, and other duties as assigned.
• Communicating as needed with the Admitting Physician, the severity and intensity of illness and the treatment plan of the patient for determination of most appropriate level of care.
• Communicating with Bed Flow Coordinator and clinical care team to collaboratively achieve effective and efficient admission processes; Working closely with MAS to improve throughput.
• Knowledge of professional nursing practice and the ability to apply the nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) with close supervision.
• Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care.
• Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.
• This nurse demonstrates the ability to cope with and manage competing priorities. Self-directed in goal setting for managing complex patient situations.
• Communicates, collaborates, and utilizes leadership principles to perform as an effective member of the interprofessional team.
• Demonstrates positive, effective communication skills and professional behaviors that promote cooperation and teamwork with internal and external customers.
• Serves as an advocate for patients, families, and caregivers, improving outcomes for the immediate practice setting. Serves as a resource for patients, caregivers, and staff to address and resolve ethical issues in the immediate practice setting.
• Leads patient care improvement through monitoring, analyzing, and evaluating care outcomes in the immediate practice setting. Leads initiatives for expanding best techniques to identify and apply patient preferences to shared care delivery decisions in the immediate practice settings.

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 07:30am - 04:00pm. Subject to changed based on the facility needs.

Telework: Ad-Hoc Only

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not Authorized

Permanent Change of Station (PCS): Not Authorized

US Department of Veterans Affairs