Utilization Management Nurse
4 weeks ago
We are seeking a skilled Utilization Management Nurse to join our team at Presidential Staffing Solutions, LLC. As a Utilization Management Nurse, you will play a crucial role in reviewing patient files and treatment methods to ensure optimal efficiency and effectiveness.
Responsibilities:- Review patient files and treatment information for efficiency and effectiveness.
- Monitor the activity of staff to ensure effective patient treatment and care.
- Advocate for quality patient care to prevent complications and ensure the best possible outcomes.
- Review discharge information for outgoing patients to ensure a smooth transition of care.
- Work closely with clinical staff to provide excellent patient care and support.
- Prepare reports on patient management and cost assessments to inform decision-making.
The ideal candidate will possess a strong understanding of professional nursing practice and the ability to apply the nursing process with close supervision. Key expectations include:
- Completing orientation according to expected standards.
- Working with close supervision, taking responsibility for individual nursing practice, and seeking direction as needed.
- Managing workload efficiently and effectively, organizing and completing assignments in a timely manner.
- Participating in the development, implementation, and evaluation of interdisciplinary care.
- Performing unit-based inpatient case management duties, including RN case management assessments, discharge planning, and formulating safe plans of care.
The successful candidate will demonstrate a commitment to Veteran/patient-driven care, patient experience, satisfaction, and safety. Key expectations include:
- Establishing a therapeutic relationship with patients, allowing them to attain, maintain, or regain optimal function through assessment and treatment.
- Engaging patients, families, and other caregivers to incorporate knowledge, values, and beliefs into care planning without judgment or discrimination.
- Knowledge of ethical issues related to professional nursing practice and adherence to established policies and the ANA Code of Ethics for Nurses.
- Awareness of high-reliability principles to deliver consistent care and improve patient outcomes.
The ideal candidate will demonstrate positive, effective communication skills and professional behaviors that promote cooperation and teamwork with internal and external customers. Key expectations include:
- Demonstrating positive, effective communication skills and professional behaviors that promote cooperation and teamwork.
The successful candidate will participate in unit-based educational activities and continuing education requirements to maintain competency and continue personal and professional growth. Key expectations include:
- Participating in unit-based educational activities and continuing education requirements.
- Responsible for maintaining competency to continue personal and professional growth.
The ideal candidate will demonstrate awareness of evidence-based practice/research to improve quality of care and resource utilization. Key expectations include:
- Applying evidence-based practice/research to patient care.
- Participating in unit-based activities to improve and deliver cost-effective patient care.
- Demonstrating knowledge of specific unit-level performance improvement activities.
- Incorporating patient preferences into shared care delivery decisions.
The incumbent will consistently communicate and treat the Veteran and as appropriate the Veteran's family, caregiver, and/or significant other, the Veteran's representative, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner. Key expectations include:
- Providing consistent information according to established policies and procedures.
- Handling conflict and problems in dealing with any consumer group appropriately and in a constructive manner.
The primary age of Veterans treated is in their middle years (ages 40 to 50) or at the geriatric level (ages 60 or older). There are occasionally younger patients between the ages of 25 to 40 years of age that require care. The position requires the incumbent to possess or develop an understanding of the particular needs of these types of patients. Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors must be consistently achieved.
Computer Security:The incumbent will protect printed and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, Federal regulations, VA statutes and policy, and VHA policy. The incumbent will protect the data from unauthorized release or from loss, alteration, or unauthorized deletion. Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the computer access agreement that the incumbent signs. Reports all known information security incidents or violations to the supervisor and/or the Information Security Officer immediately. Reports all known privacy incidents or violations to the Privacy Officer immediately. Compliance is measured by supervisory observation and periodic random monitoring by the Information Security Officer or Office of Information Technology staff. Major violations such as loss of or unauthorized release, alteration, or deletion of sensitive data are unacceptable.
Qualifications:- BSN and/or MSN preferred.
- Minimum of 5 years of successful nursing practice, encompassing education, administration, leadership, and Quality Management Performance Improvement (QM/PI) experience preferred.
- Basic computer literacy proficiency with the use of Microsoft Office programs or comparable word processing, spreadsheet, and graphic software and the ability to learn new programs specific to the VA preferred.
- Ability to work variable and flexible tours to meet program demands.
- Demonstrated ability to accurately implement policies, regulations, standards of care, and standards of practice preferred.
- Demonstrated ability to review patient clinical records.
- Proven ability to facilitate group problem-solving preferred.
- Proven ability to utilize sound judgment in making patient transfer decisions preferred.
- Ability to lead and effectively direct staff within program unit/team/group preferred.
- Excellent organizational, communication, writing, and time management skills preferred.
- Excellent interpersonal skills and the ability to work independently as well as collaboratively with multiple service lines and disciplines preferred.
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