Clinical Review Nurse I-III

Location
Birmingham, AL
Salary
Competitive
Posted
Jun 11, 2018
Closes
Jul 11, 2018
Contract Type
Permanent
Hours
Full Time
* Utilizes comprehensive knowledge of nursing clinical practice and case management principles to assess appropriate level of care and to ensure compliance with established Non-VA care authorizations and guidelines resulting in approvals and/or denials for non-VA care.
* Conducts clinical reviews to interpret and evaluate complex data directly related to diagnosis, condition, and treatment to assure appropriate medical necessity, appropriate care coordination, and timely utilization of non-VA health care services.
* Demonstrates knowledge of complex automated data processing systems and their application for communication and data management. (e.g., VISTA, CPRS, VHA Intranet, FBCS, Microsoft Word, Excel and Outlook)
* Compiles data and clearly communicates care coordination outcome data systematically as requested for improvement in organizational processes.
* Provides direct support for the development, coordination, maintenance, and operation for clinical care coordination within the Non-VA care program at the facility level and/or VISN level.
* Demonstrates continuity and timeliness of the clinical review activities, coordination with Non-VA care cycle processes, and resolution of problems to maximize team efforts.
* Communicates effectively both orally and in writing with professional, administrative, and technical staff within the medical center and non-VA organizations and/or providers as needed to coordinate non-VA services.
* Promotes excellence in customer service, internal/external by incorporating the VHA Core Values (integrity, commitment, advocacy, respect, excellence) into daily practice and performance
* Conforms to VHA regulations governing consent to release information, ensures confidentiality of all patient information, and guides others to protect patient/family rights
* Identifies resource utilization patterns and changes that influence efficiency, quality of service, appropriateness of care, and minimization of inappropriate expenditures.
* Attends in-services and continuing education programs to improve or enhance skills and knowledge.
* Regularly reports emergent Non VA Care received in the private sector after recent VA procedure or surgery to appropriate Quality/Risk Mangers
* Incumbent will operate the phone lines for clinical certification calls/faxes from physician office and imaging center staff members request authorization for clinical services for their patients.

Basic 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. (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.
  • 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.

Preferred Experience: The candidate should possess a strong knowledge base in financial and clinical aspects of care. They should have a working knowledge of health care resource utilization and/or care management; effective skills in managing, teaching,negotiating, and collaborating with multidisciplinary groups (such as local community and VA resources with client/family focus). Possess five (5) years of increasingly complex nursing practice and display evidence of self-direction and have interest in the application of Care Management and Utilization Review activities/programs. Have broad knowledge of clinical treatment modalities and be proficient in database management and also an in-depth knowledge of accreditation standards.

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.

Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office.

Physical Requirements: Long periods of sitting in one location are required in completing transactions, using a computer with dual monitors as well as other standard office equipment.None

To apply for this position, you must provide a complete Application Package which includes:
  • 10-2850A AND LATEST PROFICIENCY REPORT
  • COPY OF VALID RN LICENSE
  • Resume
  • SF-50
  • Transcript

VA Form 10-2850a - (REQUIRED AT TIME OF APPLICATION) 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), SF-50's, etc.
  • 10-2850A AND LATEST PROFICIENCY REPORT
  • COPY OF VALID RN LICENSE
  • Resume
  • SF-50
  • Transcript

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