Summary
The Patient Flow - Utilization Management Coordinator Registered Nurse (RN) considers all characteristics of the individual - in order to assist each patient with the improvement of his/her health status to the maximum potential. He/she utilizes elements of performance including knowledge and active participation in unit level quality improvement processes - such as the customer service program.
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
- 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)
- 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
- 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/12838908
- 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
- Preferred Experience: BSN with two years of case management and utilization experience
- Five years of clinical experience in acute/critical care
- Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
- Physical Requirements: This position requires visual acuity - keen hearing - clear distinctive speech - and manual dexterity
- This position requires potentially long periods of continued walking - standing - stooping - sitting - bending - pulling - and pushing
- Transferring patients and objects may be required
- Mechanical lifts are provided
- The incumbent may be exposed to infected patients and contaminated materials and may be required to done protective clothing in isolation situations - operative/invasive procedures - or home settings
- The incumbent may occasionally be exposed to patients who are combative secondary to delirium - dementia - or psychiatric disorders
- Must complete annual Employee Health requirements as a condition of employment
- The incumbent who provides care in home settings or other off-site locations may be required to drive and/or ride in GSA-vehicles.
Duties
- Major duties/functions include - but are not limited to: The primary purpose of the Patient Flow - Utilization Management Coordinator RN position is to deliver fundamental - knowledge-based care to assigned patients while developing technical skills on this assigned unit where conditions and treatment are normally of a noncritical nature
- The Patient Flow -Utilization Management Coordinator RN oversees all facility patient flow in and out of the Washington DC VA Medical Center and performance-based initiatives within the department and facility
- The Patient Flow - Utilization Management Coordinator RN is responsible for conducting formal evaluations{prospective - concurrent - and/or retrospective) and consultation to the medical center staff related to the insurance plan coverage - medical necessity - efficiency - or appropriateness of health care services and treatment plans for all patients who receive care at the Medical Center
- He/she serves as a consultant to patient care programs and the various service lines for evaluating and recommending appropriate levels of care and services using standardized criteria (InterQual)
- He/she provides support to the Quality Management Department and performs other duties as assigned
- He/she serves as a consultant and advisor to the Chief of Staff - physicians - and Service Line Managers assisting them with appropriate utilization of resources
- The Patient Flow - Utilization Management Coordinator RN initiates referrals to other disciplines and/or services appropriately
- He/she accurately documents in the medical record patient findings - assessments - and care provided
- The Patient Flow - Utilization Management Coordinator RN assigns staff to provide care based on staff competencies and identified priorities to ensure safe and effective patient care
- He/she demonstrates and/or verbalizes correct responses to emergencies - manages complex patient situations and initiates effective action in emergencies
- He/she demonstrates understanding of infection control precautions appropriate for the Utilization Management Coordinator RN
- 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 Work Schedule: Monday-Friday
- 7:00am-3:30pm
- May be subject to change based on the needs of the facility - department - and/or agency
- Telework: Not Available Virtual: This is not a virtual position
- Relocation/Recruitment Incentives: Not Authorized
- Permanent Change of Station (PCS): Not Authorized.
