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RN Utilization Management

4 months ago

Atlanta, Georgia, United States Veterans Health Administration Full time

Duties include by are not limited to:

  • This is a Pre-Admission Screening position located in the Emergency Department
  • shifts are three 10am-10pm one week, three 10am-10pm and one 10am-6pm the other week, with rotating every third weekend.
  • Promotes effective and efficient utilization of clinical resources.
  • Mobilizes resources as needed to achieve expected goal within the desired timeframe.
  • Possesses intimate knowledge of lnterQual criteria, utilization management processes, clinical documentation requirements, current standards of care, and compliance guidelines.
  • Conducts reviews for appropriate utilization of services from preadmission through discharge.
  • Conducts concurrent medical record reviews using specific indicators and criteria approved by the medical staff.
  • Interprets, applies, and enters data into National Utilization Management Integrated (NUMI) software.
  • Assesses patient care required throughout the continuum of care for diagnosis, procedures, and DRG's.
  • Communicates with providers and Physician Utilization Management Advisors (PUMA) at regular intervals throughout the hospitalization and develops effective working relationships. Assists providers in maintaining appropriate cost, care, and desired patient outcomes.
  • Participates in daily interdisciplinary care rounds and/or conferences to review supporting documentation and treatment goals, to optimize resource utilization, and to recommend alternate levels of care when acute care is no longer needed.
  • Assists in providing direction and participates in the development and implementation of policies and protocols in order to provide advice and guidance in managing special cases or meeting patient needs.
  • Evaluates clinical outcomes of nursing practice
  • Demonstrates leadership in analyzing and implementing strategies specific to patient care issues.
  • Tracks, trends, and analyzes appropriate data.
  • Participates in interdisciplinary committees/teams/task forces focused on utilization management data and organizational performance.
  • Maintains knowledge and application of patient safety concepts and principles.
  • Uses professional standards of care and practice to guide nursing practice.
  • Performs other medical record reviews as needed in support of VAHCS.
  • In the role of Pre-Admission Screener, evaluates all potential admissions for appropriate level of care, collaborates with providers, and makes recommendations as needed to insure documentation and admission orders support appropriate level of care.
  • Takes responsibility for any other duties as assigned.
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: 10am-10pm and rotating weekends

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