Registered Nurse Utilization Management Case Manager

<p>The Utilization Management (UM) Registered Nurse (RN) is responsible for reviewing medical necessity, level of care appropriateness, and compliance with regulatory guidelines to ensure effective utilization of hospital resources. The UM RN collaborates closely with physicians, case managers, social workers, and interdisciplinary teams to support appropriate patient status determination, timely transitions of care, and optimal resource utilization.</p><h3>Major Duties</h3><p>The Utilization Management (UM) Registered Nurse (RN) duties and responsibilities include, but are not limited to, the following: Perform admission continued stay, and concurrent utilization review using evidence-based criteria such as InterQaul Determine appropriate patient status (inpatient, observation, outpatient) based on medical necessity Collaborate with physicians and physician advisors regarding level of care determinations Identify avoidable delays and barriers affecting length of stay Participate in interdisciplinary daily huddle to support patient flow and discharge planning Assist with prolonged stays for timely intervention Provide cross-coverage for the Inpatient case management responsibilities as needed Preferred Experience: Minimum 3 years of acute care nursing experience required; Prior case management, utilization review, or discharge planning experience preferred; Knowledge of Medicare, Medical, and 3rd party insurance; Strong clinical judgment and critical thinking skills; and Excellent communication & interdisciplinary collaboration abilities 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, Saturday Rotation Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Available Permanent Change of Station (PCS): Not Authorized</p><h3>Requirements</h3>U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). You may be required to serve a probationary period. Complete all application requirements detailed in the "Required Documents" section of this announcement.