Utilization Management Registered Nurse

Summary This position is located within the Nursing Service at the James A. Haley Veterans' Hospital in Tampa - Florida. The Utilization Management (UM) Nurse within the Quality Management Service Line. The incumbent provides clinical review - utilization oversight - and supports the organization's mission by ensuring Veterans receive care in the appropriate setting based on evidence-based criteria. 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: 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 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: Utilization Management (UM) in VA Healthcare plays a critical role in helping the VA manage and control healthcare costs by preventing the overuse - misuse - or underuse of medical services By reducing unnecessary or redundant medical procedures and promoting cost-effective treatments - UM enables the VA to manage its budget more effectively Effective UM ensures the optimal use of limited healthcare resources - including hospital beds - medical tests - and medical equipment (such as CT and MRI scanners) Through careful review and guidance - UM advises on the appropriate level of care for each patient - helping to ensure that Veterans receive the right care at the right time This approach minimizes unnecessary delays and waste - allowing more Veterans to access the care they need By prioritizing efficient and effective resource allocation - UM supports the VA's mission to deliver high‑quality healthcare to Veterans - maximizing the impact of available resources and improving overall patient outcomes Reference: For more information on this qualification standard - please visit Physical Requirements: This position requires visual acuity - keen hearing - clear distinctive speech - and manual dexterity The work is primarily sedentary but may require periods of walking - standing - bending - and lifting light items such as papers - office materials - or medical records The incumbent must be able to sit for prolonged periods while reviewing medical documentation and operating a computer Occasional travel within the medical center and to affiliated sites may be required The position demands the ability to concentrate - analyze information - and work effectively under pressure with multiple deadlines The incumbent must demonstrate emotional and mental stability to perform the essential functions of the position and interact professionally with patients - staff - and interdisciplinary teams. Duties The Utilization Management Nurse functions within the Quality Management Service Line - performing clinical review - assessment - and coordination activities that support appropriate levels of care for Veterans The incumbent applies evidence-based criteria to evaluate the medical necessity - timeliness - and efficiency of healthcare services Working collaboratively with interdisciplinary teams - the nurse helps ensure resources are used effectively and that Veterans receive high-quality care aligned with VA policies - regulatory standards - and clinical guidelines This position supports continuous performance improvement - regulatory compliance - and optimal patient flow across the medical center The major duties of this position include - but are not limited to: - Conducting concurrent - retrospective - and prospective utilization reviews to determine the appropriate level of care and medical necessity across inpatient services Applying standardized utilization management criteria and clinical judgment to assess treatment plans - diagnostic testing - and hospital admissions or continuations of stay Monitoring for overuse - underuse - or misuse of services and communicating identified concerns to providers - care teams - and leadership for timely resolution Coordinating with interdisciplinary teams to address barriers to care - promote timely transitions - and ensure Veterans receive the right care at the right time Documenting UM - findings and recommendations accurately and consistently in accordance with VA and facility guidelines Preparing - analyzing - and presenting utilization data and trends to support quality improvement - performance measures - and organizational decision-making Supporting compliance with Joint Commission standards - VHA directives - and other regulatory requirements related to utilization management and resource stewardship Participating in committees - workgroups - and initiatives related to UM - performance improvement - patient flow - and quality management 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 - 0730-1600 Flexibility may be required based on operational needs Telework: Not Available Virtual: This is not a virtual position Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized #J-18808-Ljbffr U.S. Department of Veterans Affairs