The Community Care Utilization Management Nurse (RN) position is assigned to Care in Community Service at the DC VA Medical Center, Washington, DC. The primary purpose of this position is to provide direct staff support to service chiefs, and others in planning, designing, integrating implanting, modifying and evaluating the effectiveness of program components and/or services to improve the quality of patient care and the appropriateness and timeliness of services provided.Learn more about this agency
Major duties and responsibilities include but are not limited to:
- Organizes and coordinates resources and services in response to individual healthcare needs along the illness and care continuum and in a multiple setting;
- Provides coordination of care and services, case finding, screening, eligibility, determination, comprehensive assessment, development, monitoring and evaluation of plan of care and use of resources and arrangement of services;
- Utilizes/applies C.F.R. for approving care in the community at VA expense for both pre-authorized outpatient and inpatient care;
- Uses Pre-established guidelines and criteria to perform review activities assuring appropriate and timely utilization of Community Care medical services;
- Analyzes medical reviews accordingly to pre-established criteria, indicating severity of illness and intensity of services rendered which require acute hospitalization;
- May serve as a case manager for Community Care service patients and intervenes when inpatients no longer need acute hospitalization and recommends and facilitates appropriate referrals for alternate levels of care;
- Ensures that resources are utilized in the most cost-effective manner while providing quality patient care;
- Applies cost benefit analysis for purchased care requests, assuring the right care is delivered at the appropriate level;
- Serves as a consultant on clinical issues, resource utilization and/or continuous improvement initiatives;
- Serves as a preceptor to new staff and/or mentor to less experienced staff; sharing knowledge with colleagues either in formal in-services or informally in best practices trends in utilization management.
Work Schedule: Primarily day shift, 7:30AM-4:00PM, 8:00AM-4:30PM; weekends shifts may be required as needed.
Financial Disclosure Report: Not required
Occasional travel - You may be expected to travel for this position.
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This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/522753200. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.