Utilization Management Nurse Manager

Summary The Utilization Management Nurse Manager functions as a generalist at the point of care for their assigned Service. He/she provides consultation to other units on individual patients and provides in-services for Utilization Management and patient flow. She/he educates staff members based on documented best practices and collaborates with Clinical Leaders throughout the health care system to develop standards of care considering evidence-based practice. Qualifications 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: 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 Preferred Experience: Advanced use & experience with Interqual - National Utilization Management Integration (NUMI) - and Patient Flow experience is required NUMI and patient flow expert within the Medical Center and primary point of contact in matters regarding Utilization Management VA Nursing Leadership experience preferred Case Management experience preferred Detail orientated with data analytics - reporting data - experience with monitoring Inter-Facility Consults (IFC) for patient scheduling Reference: For more information on this qualification standard - please visit Physical Requirements: Heavy lifting - 45 pounds and over - Moderate carrying - 15-44 pounds - Straight pulling(2 hours) - Pushing(1 hours) -Reaching above shoulder - Use of fingers - Both hands required - Walking(8.0 hours) - Standing(6.0 hours) - Kneeling(1/4 hours) - Repeated bending(1 hours) - Both legs required - Ability for rapid mental and muscular coordination simultaneously - 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 - Specific visual requirement (specify) Read medication labels - Both eyes required - Depth Perception - Ability to distinguish basic colors - Ability to distinguish shades of colors - Hearing (aid permitted) - Mental and Emotional Stability Environmental Factors: Excessive humidity - Excessive dampness or chilling - Excessive noise - intermittent - Radiant energy - Electrical energy - Slippery or uneven walking surfaces - Unusual fatigue factors (specify) working - Working with hands in water - Working closely with others - Working alone - Protracted or irregular hours of work - Other (specify) irregular hours of work - wearing aseptic mask Duties The UM Nurse Manager develops and participates in all aspects of unit Quality Improvement (QI) projects and implements quality improvement The UM Nurse Manager executes position responsibilities that demonstrate leadership - experience - and creative approaches to management of complex client care UM Nurse Manager is responsible for documenting outcomes at the program or service level and demonstrates Leading and organizing delivery of care to assure continuity - enhancing peer accountability for practice - including access to care and discharge planning Using advanced clinical knowledge/judgment to promote staff involvement in planning - decision-making - and evaluating outcomes Functioning as an expert in clinical practice and/or areas related to the assigned roles and responsibilities Systematically evaluating current practice - and formulating outcomes for groups of patients and/or organizational processes within an area of expertise Using professional standards of care - scientific evidence - and practice to evaluate programs and/or service activities Attends interdisciplinary meetings daily and attend any staff - national or VISN meetings assigned Completes additional projects as requested by Chief Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others Utilization Management Registered Nurse is a PROFICIENT nurse - "who understands a situation as a whole because they perceive its meaning in terms of long-term goals The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events The Utilization Management Nurse Manager (NM) is the designated first-line supervisory authority and is responsible and accountable for the operation of their assigned units and provides coverage for other NMs as needed The UM Nurse Manager serves as a Utilization Management - NUMI and patient flow expert within the Medical Center and primary point of contact in matters regarding Utilization Management The UM Nurse Manager has 24-hour accountability for the care provided by self and others to whom care is delegated The UM Nurse Manager is a subject matter expert (SME) in areas related to Utilization Management - efficiency - patient transfers - and traveling Veteran needs obligated to ongoing - comprehensive evaluation and improvement of clinical practice and healthcare delivery systems to meet the needs of patients The UM Nurse Managers role includes - but is not limited to: monitoring Inter-Facility Consults (IFC) for patient scheduling - oversight and evaluation of arranging traveling Veterans accommodations and needs are met Utilizes the National Utilization Management Integration (NUMI) tool to evaluate clinical review data and ensure subordinate staff are performing at optimal levels while maintaining the best and most efficient care possible The UM Nurse Manager will focus on the following priorities: collecting - analyzing - evaluating and summarizing data related to demand - capacity management and inter-facility consults coordinates and facilitates patient appointments - including those made with labs - diagnostic areas - and specialty providers monitoring patients Electronic Medical Record (EMR) for demographic updates - changes in needs - and appointment updates develop and utilize systems and data management tools to facilitate the identification of patients for navigation 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 change based on the facility needs Telework: Ad-HOC Virtual: This is not a virtual position Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized #J-18808-Ljbffr Direct Jobs