Vacancy Identification Number (VIN): 11139650 Please refer to "Required Documents" section to ensure eligibility. 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. The Referral Consult Team (RCT) Consult Manager is a registered nurse responsible for the planning, integrating, implementing and modifying the effectiveness of the Veteran's care. RN possesses intimate knowledge of Fee federal regulations, VHA guidelines, medical review criteria, utilization management processes, clinical documentation requirements, current standards of care, and compliance guidelines. RN uses nursing knowledge and systems theory to assess, organize and facilitate appropriate clinical services to patients. The Registered Nurse will serve as a liaison to both internal and external providers and will be responsible for managing the care of the Veteran throughout the consult process. Clinical oversight of the non-VA care approval process is provided by the medical center Chief of Staff and nursing professional practice oversight by the Associate Director, Patient Care Services. RN supports the medical center's mission by possessing and exemplifying the Four Core Competencies of the High-Performance Model. Performed duties will include, but not limited to: Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care within VHA and the non-VA care program. - Responsible for organizing and coordinating the clinical components for the consult determination in response to individual healthcare needs along the illness and care continuum and in multiple settings. - Utilizes comprehensive knowledge of advanced clinical practice and case management principles to assess appropriate level of care and to ensure compliance with established Fee authorities and guidelines resulting in approvals and/or denials for non-VA care. - Conducts clinical reviews to interpret and evaluate complex data directly related to diagnosis, condition, and treatment to assure appropriate medical necessity, appropriate care coordination and timely utilization of non-VA health care services - Utilizes applicable technical skills in maintaining tracking methods for data retrievaland for ensuring accurate meaningful reporting system. - Compiles data and clearly communicates care coordination outcome data systematically as requested for improvement in organizational processes. - Promotes excellence in customer service, internal and external, by incorporating the VA Core Values (Integrity, Commitment, Advocacy, Respect, and Excellence) into daily practice and performance. - Demonstrates evidence of critical thinking skills in identifying, analyzing, and resolving patient care problems. - Assumes the role of patient advocate in the patient's interactions with the other members of the Medical Center staff and the services provided. - Abides by and carefully adheres to Medical Center Policies for Ethics and Compliance. - Identifies resource utilization patterns and changes that influence efficiency, quality of service, appropriateness of care, and minimization of inappropriate expenditures. - Collaborates with other health professionals to ensure quality medical care is provided in a timely manner and patients' needs, whether perceived or real, are addressed and met Utilizes systems thinking to monitor non-VA program elements and identify core needs of multidisciplinary staff regarding Fee Basis program regulations and requirements and implements a plan to resolve those needs. - Serves as a role model in interacting with patients, families andsignificant others in a professional manner and utilizing effective communication skills. - Resolves conflict and assists others in coping with stressful situations. - Identifies problem areas for monitoring and evaluation, active in analyzing findings and changing practice based on quality improvement findings with resultant improvement in patient care. - Demonstrates flexibility/adaptability when initiating projects for the development of processes to identify adverse patient occurrences and to improve patient services and clinical practice. Work Schedule: Monday - Friday 8:00am - 4:30pm Financial Disclosure Report: OGE Form 278e Filing: This position is NOT required to file the Public Financial Disclosure Report.
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.