Registered Nurse (Community Care Utilization Management)
The Community Care, Utilization Management Nurse (CCUM) is responsible for providing expert leadership with the clinical expertise in the support of the medical center's CCUM program. He/she possesses expert knowledge of InterQual Acute Criteria, utilization management best practices, clinical documentation requirements, current standards of care, and compliance guidelines (Joint Commission, Inspector General, Veterans Integrated Service Network (VISN), etc.) The CCUM Nurse is accountable for initiating critical thinking skills and comprehensive judgment to ensure positive outcomes, capitalize on third party collections, and the delivery of quality patient care services. He/she supports the medical center's mission by possessing and exemplifying the Eight Core Competencies of the High Performance Model.
The CCUM Nurse performs review for all Community Care requests, prospective, admission, and continued stay utilization reviews for patients at the Acute level of Care and assists with reviews for the Community Living Center. S/he assists in the screening committee, applying InterQual criteria as one of the screening tools for admission. The CCUM Nurse collaborates with the Chief Care Integration Service, Nurse Manager Care Integration Service, Supervisor Care Integration Service when second level reviews for community care requests is necessary and the Saginaw VA Medical Center's (VAMC) Physician Advisor when proposed admissions require a second-level review. The Chief of Staff is the point of contact should a third-level review be required.
The CCUM Nurse reports directly to the Community Care Nurse Manager. Duties include but are not limited to:
- Applies the nursing process to system or processes at the unit/work group level to improve patient care. Demonstrates leadership by involving others in improving patient care. (Technical Skills: High Performance Development Model.
- Collaborates with providers, other members of the health care team, other disciplines to coordinate care including initiating appropriate referrals, communicating ongoing patient status, identifying barriers to care, exploring motivational and adherence issues, evaluating support systems, and examining patterns of over and underutilization of services. This collaboration may be intra-facility, inter-facility, within VAMC or within Private Sector.
- Provides consultation to health care teams by analyzing ethical/care issues and appropriate theoretical principles providing guidance as appropriate.
- Serves as a resource and advocate for the protection of patient/family rights.
- Identifies and assesses resource utilization and safety issues, taking appropriate actions.
- Participates in emergency preparedness activities including utilizing appropriate evacuation technique, knowledge of responsibilities.
- Participates in educational activities to improve clinical knowledge and enhance role performance.
- Evaluates practices of self and others using professional standards, relevant statutes, and regulations; takes appropriate actions to improve identified deficiencies.
- Uses the group process to identify, analyze and resolve care problems. (Customer Service and Systems Thinking).
- Educates colleagues and/or students and serves as a preceptor and/or mentor. (Interpersonal Effectiveness).
- Initiates educational activities for other staff. Examples include conducting in-services, developing handouts or protocols.
- Demonstrates flexibility/adaptability when initiating and leading interdisciplinary projects to assist in the facilitation of utilization management initiatives, and the development of processes, which result in the improvement of resource utilization and reimbursement.
- Demonstrates organizational stewardship in the initiation of improvement activities in utilization management and third party reimbursement working closely with the Medical Care Cost Recovery (MCCR) Insurance Review Nurse and Personnel Accountability System (PAS) Coders.
- Reviews current utilization review literature, health care research and changes in technology and procedures to evaluate current practices and identify opportunities for improvement in the delivery of patient care services, utilization management, and third party reimbursement. Initiates change in practice based on these findings.
Financial Disclosure Report: Not RequiredBasic Requirements:
- United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
- Graduate of a school of professional nursing approved by the appropriate State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing.
- OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript.
- 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.
- 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.
- English Language Proficiency. RNs appointed to direct patient care positions must be proficient in spoken and written English as required by 38 U.S.C. 7402(d) and 7407(d).
Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade:
- Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
- Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience.
- Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience.
- Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required.
- Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 year's of nursing practice/experience; OR a Doctoral degree.
Physical Requirements: The work is primarily sedentary in an office setting, although some slight physical effort may be required. Included are walking, standing, bending, carrying of light items and occasionally assisting with a patient in a wheel chair. In some instances, relationship with staff across a variety of departments over issues of customer dissatisfaction may become intense and the employee may be placed in a position of stress.
Selected applicants will be required to complete an online onboarding process.
To apply for this position, you must provide a complete Application Package which includes:
o Education: including name and location of college, dates attended, and type and date of any degree earned and/or a copy of your college transcripts (If selected, official transcript will be required).
o Licenses and/or certificates earned or a copy of your license.
If you are a current Aleda E. Lutz Employee: You must submit a copy of your most recent Notification of Personnel Action (SF50), this cannot be an award SF50.
VA Form 10-2850a - Application for Nurses and Nurse Anesthetists can be found at: http://www.va.gov/vaforms/search_action.asp?FormNo=2850&tkey=&Action=Search.
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), etc.
- Cover Letter
- Other Veterans Document