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    The incumbent demonstrates leadership in delivery and improving holistic care through collaborative strategies. Responsible for development and implementation of utilization management. Coordinates identification and improvement in patient care efficiencies, ensures appropriateness of delivery of medical interventions and reduction in variations of care per guidelines. Improves utilization of resources to maximize ability for reimbursement based on accurate, timely data and information.

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    Responsible for the development and implementation of utilization management within the VA Black Hills Health Care System. The coordinator will identify and improve efficiencies of patient care; ensure appropriateness in the delivery of medical interventions and reduce variations. The coordinator will also improve utilization of resources to maximize the medical center's ability for reimbursement based on accurate and timely data and information. The coordinator is the leader of change in the program, and is responsible for communicating policy and procedure changes and for monitoring compliance with them. The nurse coordinator also models professional nursing practice by participating actively in shaping evidence-based practice in the medical center through his/her work on nursing and interdisciplinary committees and task forces.
    Primary responsibilities of the UM Nurse Coordinator include:
    - Assures the competence of staff by coordinating the InterQual training and provide ongoing oversight of utilization review criteria.
    - Collaborates with Director of Organizational Improvement on determining needs of the program, needed education and training of providers and data collection.
    - Communicates the mission, vision and values of the organization to staff and leads implementation of the strategic plan as it relates to the UM program.
    - Acts as primary program change agent by communicating, promoting and monitoring compliance with new policies and procedures and by proposing innovative solutions to team needs/conflicts
    - Leads Performance Improvement efforts in the Performance Improvement area.
    - Collaboration with all service line staff and leadership to assure quality patient care with placement of patients in appropriate levels of care
    - Facilitates medical center committees or task forces for performance improvement initiatives.
    - Effectively communicates with other departments regarding the needs of or issues pertaining to the UM program.
    - Develops and maintains positive, effective relationships with the bargaining units.- Accountable for accurate and complete data collection, entry, and reports to the VISN.
    - Data analysis to identify utilization patterns and trends in practice
    - Provide UM consultation and education as needed.Unique competencies required for this role include
    - The ability to motivate and influence staff.
    - The ability to mediate conflict and facilitate positive solutions.
    - Sufficient clinical competence to enable the manager to evaluate clinical competence of staff and have the knowledge and experience to propose/facilitate solutions to clinical issues.
    - Strong time-management and organizational skills
    - Expertise in common computer applications as well as ability to run reports and analyze data.
    - Knowledge of how to run effective meetings and how to effectively manage projects
    - Knowledge of Performance Improvement methods and process, including basic quantitative analysis.
    - Skill in promoting teamwork and building positive relationships.
    - Ability to develop programs, processes and policies.
    - Strong communication skills.- Ability to provide educational programs to staff
    - Understanding of UM program, review/criteria requirements, Preadmission Screening Program, Referral Case Management, Bed Coordination, and report requirements.

    Work Schedule: Monday - Friday 7:30am - 4:00pm
    Financial Disclosure Report: Not required

    Travel Required

    Occasional travel - You may be expected to travel for this position.

    Supervisory status


    Promotion Potential


  • Job family (Series)

    0610 Nurse

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/546960900. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.