The Utilization Management (UM) Staff RN has responsibility for coordination and implementation of the Utilization Management program for patients admitted to the inpatient units within the facility. UM Staff RN functions in all patient care locations to determine compliance of UM criteria with all healthcare interdisciplinary teams. UM Staff RN will perform other duties under the direction of the Nurse Manager or designee as assigned. This position is not open to novice nurses. UM Staff RN will have superior critical thinking skills, effective communication and teaching skills. UM Staff RN activities must reflect the highest standards that are consistent with the mission, values, priorities, goals and resources of BPVAHCS. Job duties of the UM Staff Rn will include but not limited to: Daily chart reviews in assigned areas for patients on observation Status, full admission, and reviews of continued stay days. Review identified patient cases to evaluate appropriate utilization of resources using pre-determined criteria. Assists with identifying and facilitating options and services [or continuous improvement in patient flow and patient care quality Conduct clinical screening of electronic patient records and related information obtained from the interdisciplinary team members Enters data into an established data base Present findings to the interdisciplinary team to best utilize resources and provide for the best level of care suitable to the needs of the patient. Must demonstrate: Knowledge of the nursing process, must be broadly acquainted with clinical treatment modalities, have a basic understanding of the organization's health care delivery systems, and knowledge of specialty and subspecialty care. Understand chart review processes and entries into databases, can run reports from the data, and understand the basics of UM policies and procedures. Knowledge and skills in Vista, CPRS, Microsoft Office products including but not limited to, Outlook, Word, and Excel and the Internet. Knowledge of pertinent laws to include the Privacy Act of 1994, HIPAA, VHA regulations, healthcare system memorandums, and service level policies. Work Schedule: Monday - Friday, 7:30AM - 4:00PM with occasional off tour coverage/training Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required
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.