Utilization Management 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 Manger Utilization Management under the auspices of the Associate Chief of Staff Clinical Operations.

• 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.
• Communicates with physicians 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.
• Communicates 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.
• Communicates with physicians 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.
• Communicates 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

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• Selective Service Registration is required for males born after 12/31/1959.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements ( Effective May 7 2025 drivers licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Must pass pre-employment physical evaluation.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• You may be required to serve a probationary period.
• Complete all application requirements detailed in the Required Documents section of this announcement.

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 masters level bridge program in nursing who have completed coursework equivalent to a bachelors 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: I Level IDelivers 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 IIDemonstrates 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 IIIDemonstrates 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 Masters degree in nursing (MSN) and no additional professional nursing experience; OR a Masters degree in a *related field with a BSN and no additional professional nursing experience.Nurse IIDemonstrates 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 Masters 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 IIIExecutes 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 Masters 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: 2 years of Case Management experience 2 years of InterQual experience 2 years of Utilization Management (UM) experience and 5 years total Registered Nurse experience.

Reference: For more information on this qualification standard please visit Requirements:
Heavy lifting 45 pounds and over Moderate carrying 15-44 pounds Straight pulling(2hours) Pulling hand over hand (.5hours) Pushing(1hours) Reaching above shoulder Use of fingers Both hands required Walking(8hours) Standing(6hours) Kneeling(1/4hours) Repeated bending(1hours) Both legs required 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 requirements(specify) Read medication labels Both eyes required Depth perception Ability to distinguish basic colors Ability to distinguish shades of colors Hearing (aid may be permitted) Mental and Emotional Stability.

Environmental Requirements:
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 Wearing aseptic mask