Clarification from the agency

Open ONLY to current, permanent employees of the VA South Texas Health Care System.

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The Lead Utilization Management (UM) RN at the VA Hospital plays a vital role in optimizing resource utilization while ensuring high-quality, patient-centered care. This position requires strong clinical knowledge, leadership skills, and the ability to collaborate effectively with various healthcare professionals to achieve efficient and effective utilization management outcomes.

The Lead Utilization Management RN reports to the Nurse Manager for Planning, Performance and Development (P2D):

• Utilization Management Oversight: The Lead UM RN takes a leadership role in monitoring and managing the utilization management processes, including reviewing medical records, coordinating with healthcare teams, and ensuring compliance with utilization management guidelines and regulatory requirements.
• Clinical Review and Decision Making: Conducting comprehensive clinical reviews of patient medical records, analyzing data, and making evidence-based decisions regarding appropriateness of care, level of care, and resource utilization. This includes reviewing medical necessity, length of stay, and discharge planning to ensure the optimal use of healthcare resources.
• Team Leadership: Providing guidance, support, and leadership to the UM RNs and other staff members involved in utilization management activities. This includes training, performance evaluation, and fostering a collaborative team environment.
• Collaboration and Communication: Collaborating with interdisciplinary teams, such as physicians, nurses, case managers, and administrators, to ensure effective communication, coordination, and resolution of utilization management issues. This includes participation in rounds, meetings, and committees related to utilization management and care coordination.
• Policy Development and Implementation: Assisting in the development, implementation, and evaluation of utilization management policies, procedures, and protocols. Staying updated with regulatory changes and industry best practices to ensure compliance and promote continuous quality improvement in utilization management processes.
• Education and Training: Providing education and training to healthcare professionals, including UM staff, regarding utilization management principles, guidelines, and processes. This includes conducting training sessions, developing educational materials, and promoting awareness of utilization management principles across the organization.
• Quality Improvement: Actively participating in quality improvement initiatives related to utilization management, such as data analysis, performance monitoring, and identification of opportunities for improvement. Collaborating with stakeholders to implement evidence-based practices that enhance patient outcomes and resource utilization.

Work Schedule: Monday - Friday, 0800-1630 (Negotiable based on agency needs and supervisor approval)
Telework: Ad-hoc may be available
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not authorized
Permanent Change of Station (PCS): Not authorized
Bargaining Unit Status: This position is part of the bargaining unit.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards
Pay: Competitive salary, regular salary increases, potential for performance awards
Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)
Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA
Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)
Licensure: 1 full and unrestricted license from any US State or territory

Conditions of employment

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• Selective Service Registration is required for males born after 12/31/1959.
• You may be required to serve a probationary period.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process.
• Must pass pre-employment physical examination.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details.

Qualifications

BASIC REQUIREMENTS

• English Language Proficiency: In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
• Education: Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant:
  • The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR
  • Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR
  • In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).
• License: Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.)

NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

PREFERRED EXPERIENCE

• Experience communicating effectively with internal and external customers
• 3-5 years recent Clinical Experience
• 2-5 years recent Interqual Experience
• Experience analyzing and compiling data
• 2-3 years experience managing teams and/or programs

Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12499590.

Grade/Level	Scope	Education
Nurse I, Level I	Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.	An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.
Nurse I, Level II	Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.	An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.
Nurse I, Level III	Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations.	An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience.
Nurse II	Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.	A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience.
Nurse III	Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.	MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

*Note: Foreign education programs/degrees are not creditable as related degrees.


Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: Moderate lifting, 15-44 pounds; Light lifting, under 15 pounds; Moderate carrying, 15-44 pounds; Straight pulling (1 hour); Pushing (1-3 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (4 hours); Standing (2-7 hours); Kneeling (2 hours); Repeated bending (2 hours); Climbing, use of legs and arms; Both legs required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16" to Jaeger 1 to 4; Vision 20/40 DVA, Corrected; Both eyes required; Ability to distinguish basic colors; Hearing (aid may be permitted); Sitting (8 hours); Simple grasping (2-4 hours); Fine manipulation (including keyboarding 4-6 hours); Twisting (2 hours); Mental and emotional stability.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, resume, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.

NOTE: Candidate's education, scope, and length of nursing practice (experience) will be considered in determining the grade and salary of the applicant selected. The recommended salary may be at any point in the range listed for this vacancy.

Experience as an RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following five dimensions of nursing: Practice, Veteran/Patient Driven Care, Leadership, Professional Development, and Evidence/Based Practice/Research. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position.

It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.