OUR MISSION: To fulfill President Lincoln's promise - "To care for him who shall have borne the battle and for his widow, and his orphan" - by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate care to Veterans? The Utilization Management (UM) Nurse executes position responsibilities that demonstrates leadership, experience, and creative approaches to management of complex patient care. The UM Nurse demonstrates performance and leadership that is broad enough to improve the care for a group of patients. The UM Nurse 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 within a facility, VISN, or VACO. Program is defined as a substantial coordinated group of activities impacting patients and/or employees. The UM Nurse performance includes though not limited to; Leading and organizing delivery of care to assure continuity of care and 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, Guiding, developing, and supporting staff from a leadership perspective, and Using professional standards of care, scientific evidence, and practice to evaluate programs and/or service activities. UM Nurse reviews medical records for all admissions and transfers into the facility and, when necessary for patient movement, transfers between levels of care to advise treating teams of InterQual criteria. The UM Nurse consults with the treatment team regarding appropriate level of care and if clinical milestones are being met in a timely manner UM nurses effect change by providing just in time information to guide evidence-based decision making, assisting in the management of daily patient flow activities, coordinating transition planning and analyzing data to promote quality improvement practices. Contacts the ER provider or admitting team when admissions do not met criteria. Assists providers to explores other alternatives for care. Provides utilization management review (UMR) to patients with complex care needs utilizing the nursing process based on the ANA Standards of Nursing Practice. Demonstrates evidence of critical thinking skills in identifying, analyzing, and resolving patient care problems Provides leadership in establishing goals, evaluating the plan of care, and in discharge planning. Initiates referrals to other disciplines and/or services as appropriate. Accurately documents reviews in NUMI. Documentation is technically informative, complete, accurate, consistent, concise, and timely. Evaluates and documents patient progress towards attainment of goals and expected outcomes related to discharge. Revises discharge goals and plan based upon on-going patient evaluation and input from healthcare team. Uses the Electronic Medical Record, Medical Administration and other approved software as needed to perform duties in assigned area. Effectively functions in the UM Reviewer role that guides and directs others in the process of InterQual review and utilization management processes. Organizes and completes own assignments in a safe and timely manner, assisting team members as necessary. Provides direction to staff for meeting patient care needs/concerns related to discharge. Uses a team approach to identify, analyze, and resolve patient care problems that result in improved patient outcomes. The nurse initiates communication with interdisciplinary team members to ensure patient is placed in appropriate level of care. Places accurate PUMA reviews in the database for their review. Participates in Inter Rater Reliability Reviews as requested. Ensure admission reviews are completed on all observations converted to admissions. Promotes adherence to infection control guidelines and practices through just in time action and on the spot education when deviation is noted. Responsible for ensuring his/her actions contribute to a mode of continued accreditation readiness regarding Joint Commission (TJC), Office of Inspector General (OIG), Commission on Accreditation of Rehabilitation Facilities (CARF), VA surveyors, Laboratory College of American Pathologists (CAP), and other survey teams. Work Schedule: Varied tours Financial Discloser Report: Not required
Internal Number: 599819100
About Veterans Affairs, Veterans Health Administration
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.