Utilization Management Registered Nurse

<p>This position is located within the Nursing Service at the James A. Haley Veterans' Hospital in Tampa, Florida. The Utilization Management (UM) Nurse within the Quality Management Service Line. The incumbent provides clinical review, utilization oversight, and supports the organization's mission by ensuring Veterans receive care in the appropriate setting based on evidence-based criteria.</p><h3>Major Duties</h3><p>The Utilization Management Nurse functions within the Quality Management Service Line, performing clinical review, assessment, and coordination activities that support appropriate levels of care for Veterans. The incumbent applies evidence-based criteria to evaluate the medical necessity, timeliness, and efficiency of healthcare services. Working collaboratively with interdisciplinary teams, the nurse helps ensure resources are used effectively and that Veterans receive high-quality care aligned with VA policies, regulatory standards, and clinical guidelines. This position supports continuous performance improvement, regulatory compliance, and optimal patient flow across the medical center. The major duties of this position include, but are not limited to: - Conducting concurrent, retrospective, and prospective utilization reviews to determine the appropriate level of care and medical necessity across inpatient services. - Applying standardized utilization management criteria and clinical judgment to assess treatment plans, diagnostic testing, and hospital admissions or continuations of stay. - Monitoring for overuse, underuse, or misuse of services and communicating identified concerns to providers, care teams, and leadership for timely resolution. - Coordinating with interdisciplinary teams to address barriers to care, promote timely transitions, and ensure Veterans receive the right care at the right time. - Documenting UM, findings and recommendations accurately and consistently in accordance with VA and facility guidelines. - Preparing, analyzing, and presenting utilization data and trends to support quality improvement, performance measures, and organizational decision-making. - Supporting compliance with Joint Commission standards, VHA directives, and other regulatory requirements related to utilization management and resource stewardship. - Participating in committees, workgroups, and initiatives related to UM, performance improvement, patient flow, and quality management. 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, 0730-1600. Flexibility may be required based on operational needs. Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized 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.