Summary

This Utilization Management Nurse position is located in Nursing Service at the VA Providence Medical Center. This position is full-time at 40 hours per week.

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: https://apply.usastaffing.gov/ViewQuestionnaire/12778995
• 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: 1-3 years Utilization Management - Nurse Case Manager
• 3-5 years of experience in inpatient acute - psychiatric - Emergency Department and/or critical care healthcare settings
• Certification in Certified Case Manager or Certified Professional in Healthcare Quality preferred
• Knowledge and ability to apply InterQual criteria - utilization management process - clinical documentation requirements - current standards of care and compliance guidelines
• Proficiency in excel and other Microsoft Office software applications
• Experience with use of EHR
• Experience in data analyses - visualization and evaluation
• Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: All applicants must be physically able to satisfactorily perform the duties of the position
• A pre-placement physical examination shall be completed prior to appointment.

Duties

• The Utilization Management (UM) registered nurse (RN) is responsible for monitoring and ensuring that Veterans that are hospitalized are admitted or transferred to the appropriate level of care - based upon InterQual Criteria
• The UM RN will execute responsibilities that demonstrate leadership - experience - and creative approaches to management of complex patient care and will improve the care for a group of patients
• The UM RN position possesses extensive knowledge of InterQual criteria - utilization management processes - clinical documentation requirements - current standards of care - and understanding of VHA compliance guidelines
• This position is accountable for utilizing critical thinking skills and sound judgement to ensure positive outcomes and delivering quality patient care performance improvement activities
• The UM RN collaborates with the interdisciplinary team when coordinating the transitioning of patients through the inpatient care setting
• The UM RN participates in interdisciplinary discharge planning rounds and advises the team about appropriate levels of care (e.g. - observation - acute - stepdown - and intensive care) based upon the treatment plan
• This position will serve as a resource person and consultant to the interdisciplinary team for problem solving related to Utilization Management concerns or issues
• UM RN also collaborates with Physician Utilization Management Advisor (PUMA) regarding appropriate levels of care when there is discordance with InterQual criteria and providers treatment plan and level of care
• Work Schedule: Full-time - 40 hours per hour
• The Providence Healthcare System is an acute care facility operating 24 hours a day 7 days a week
• While most tours of duty are scheduled during the day - the possibility of working evenings - nights and weekends does exist
• Shift changes may be considered by the service based on patient and facility needs
• Compressed/Flexible: May be Authorized Telework: May be eligible for ADHOC Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Notifications: This is a not Bargaining Unit Position This position is in the Excepted Service Current and former Federal employees must submit copies of their most recent SF-50 - (Notice of Personnel Action)
• The SF-50 must identify the position title - series - grade - step - tenure and type of service (Competitive or Excepted)
• In some cases - more than one SF-50 may be required to show a higher grade previously held
• This position is covered by a special rate
• 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