Registered Nurse (Utilization Management)
Collaborates with Quality Management and interdisciplinary teams to establish and maintain policy and procedures to ensure compliance with associated standards and VHA Directives. The UM Nurse(s) provides associated education to clinical staff:
and provide clinical and administrative recommendations relative to programs, committees, and/or services that relate to care and utilization management as an approach to assess and improve the quality of healthcare services, including the utilization of resources. In addition to providing clinical and administrative recommendations, the UM Nurse(s) will provide guidance to interdisciplinary teams, leadership and administrative personnel through systematic evaluation and assessment of quality of care and services. current clinical practices and administrative processes. The UM Nurse(s) will initiate programmatic changes in practices and/or processes based on current concepts and findings from research, data and Evidence-Based Practice. The UM Nurse(s) will utilize specialized expertise to assess, design, measure and/or evaluate all UM Program processes and procedures. Facilitates, supports, and assures completion of ongoing assessments and quality monitoring actions by service/subject matter experts to evaluate compliance with evidence-based practice standards by using National Utilization Management Integration (NUMI) database. The incumbent(s) reviews current documentation and data as required for continual patient care:
completes chart reviews and applications; and provides consultation and support to all levels of facility leadership, the Quality Management Chief, and others responsible for Dorn Utilization Management activities, including all UM related requirements, Dorn VAMC policy initiation/revision, Inter-Rater Reliability training, and development, implementation, and monitoring of facility InterQual compliance. Ensures that senior leaders are fully informed about the UM program and engaged in final compliance decisions and approval processes for program related products and activities, as appropriate. Participates on Dorn VAMC committees as a utilization management resource and quality content expert; educates staff about evidence-based practice standards, various levels of care, and VA/VHA/VISN/Dorn VAMC guidance and processes. Work Schedule:
Monday - Friday, 8:
00 am to 4:
30 pm. Subject to change based on the needs of the agency. Financial Disclosure Report:
Not required Basic Requirements:
United States Citizenship:
Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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. 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. Grade Determinations:
The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade:
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 year's of nursing practice/experience; OR a Doctoral degree and approximately 2-3 year's of nursing practice/experience. NOTE:
Nurse III must demonstrate performance and leadership that is broad enough to improve the care for a group of patients. The Nurse III is responsible for the documented outcomes at the program or service level. Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level. In order to be considered for appointment to Nurse III, outcomes must be documented. Meeting the Practice dimension involves incorporating and implementing the requirements of the other qualification standards, including:
(a) Leading and organizing delivery of care to assure continuity of care and peer accountability for practice, including access to care and discharge planning. (b) Using advanced clinical knowledge/judgment to promote staff involvement in planning, decision-making and evaluating outcomes. (c) Functioning as an expert in clinical practice and/or in areas related to the assigned roles and responsibilities. (d) Systematically evaluating current practice, and formulating outcomes for groups of patients and/or organizational processes within area of expertise. (e) Guiding, developing and supporting staff from a leadership perspective. (f) Using professional standards of care, scientific evidence and practice to evaluate programs and/or service activities. Reference:
VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements:
The population of male and female veterans served ranges from the adult, age 18, to the elderly adult, age 65 and over. Dorn VAMC is a major interdisciplinary teaching facility, serving medical, surgical, and neurological inpatients and outpatients. There is a large outpatient psychiatric population, with admissions for medical co-morbidities. This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. Lift 45 pounds or over, carry 45 pounds or over; reaching above the shoulders, emotional stability, ability to distinguish basic and shades of color; The incumbent may be exposed to infected patients and contaminated materials and may be required to don personal protective clothing in isolation situations or operative/invasive procedures. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs.
Estimated Salary: $20 to $28 per hour based on qualifications.
and provide clinical and administrative recommendations relative to programs, committees, and/or services that relate to care and utilization management as an approach to assess and improve the quality of healthcare services, including the utilization of resources. In addition to providing clinical and administrative recommendations, the UM Nurse(s) will provide guidance to interdisciplinary teams, leadership and administrative personnel through systematic evaluation and assessment of quality of care and services. current clinical practices and administrative processes. The UM Nurse(s) will initiate programmatic changes in practices and/or processes based on current concepts and findings from research, data and Evidence-Based Practice. The UM Nurse(s) will utilize specialized expertise to assess, design, measure and/or evaluate all UM Program processes and procedures. Facilitates, supports, and assures completion of ongoing assessments and quality monitoring actions by service/subject matter experts to evaluate compliance with evidence-based practice standards by using National Utilization Management Integration (NUMI) database. The incumbent(s) reviews current documentation and data as required for continual patient care:
completes chart reviews and applications; and provides consultation and support to all levels of facility leadership, the Quality Management Chief, and others responsible for Dorn Utilization Management activities, including all UM related requirements, Dorn VAMC policy initiation/revision, Inter-Rater Reliability training, and development, implementation, and monitoring of facility InterQual compliance. Ensures that senior leaders are fully informed about the UM program and engaged in final compliance decisions and approval processes for program related products and activities, as appropriate. Participates on Dorn VAMC committees as a utilization management resource and quality content expert; educates staff about evidence-based practice standards, various levels of care, and VA/VHA/VISN/Dorn VAMC guidance and processes. Work Schedule:
Monday - Friday, 8:
00 am to 4:
30 pm. Subject to change based on the needs of the agency. Financial Disclosure Report:
Not required Basic Requirements:
United States Citizenship:
Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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. 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. Grade Determinations:
The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade:
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 year's of nursing practice/experience; OR a Doctoral degree and approximately 2-3 year's of nursing practice/experience. NOTE:
Nurse III must demonstrate performance and leadership that is broad enough to improve the care for a group of patients. The Nurse III is responsible for the documented outcomes at the program or service level. Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level. In order to be considered for appointment to Nurse III, outcomes must be documented. Meeting the Practice dimension involves incorporating and implementing the requirements of the other qualification standards, including:
(a) Leading and organizing delivery of care to assure continuity of care and peer accountability for practice, including access to care and discharge planning. (b) Using advanced clinical knowledge/judgment to promote staff involvement in planning, decision-making and evaluating outcomes. (c) Functioning as an expert in clinical practice and/or in areas related to the assigned roles and responsibilities. (d) Systematically evaluating current practice, and formulating outcomes for groups of patients and/or organizational processes within area of expertise. (e) Guiding, developing and supporting staff from a leadership perspective. (f) Using professional standards of care, scientific evidence and practice to evaluate programs and/or service activities. Reference:
VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements:
The population of male and female veterans served ranges from the adult, age 18, to the elderly adult, age 65 and over. Dorn VAMC is a major interdisciplinary teaching facility, serving medical, surgical, and neurological inpatients and outpatients. There is a large outpatient psychiatric population, with admissions for medical co-morbidities. This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. Lift 45 pounds or over, carry 45 pounds or over; reaching above the shoulders, emotional stability, ability to distinguish basic and shades of color; The incumbent may be exposed to infected patients and contaminated materials and may be required to don personal protective clothing in isolation situations or operative/invasive procedures. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs.
- Department:
0610 Nurse - Salary Range:
$53,680 to $101,575 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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