at Veterans Affairs, Veterans Health Administration in Hines, Illinois, United States
Job Description
Summary The Utilization Management (UM) Nurse Manager (NM) is a registered professional nurse responsible for the assessment, planning, provision and evaluation of UM Program. The UM NM serves as a role model, educator, practitioner, and manager-providing leadership to the UM RN team. The UM NM executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client cases as it relates to the practice of utilization management. Responsibilities The Utilization Management (UM) Nurse Manager (NM) is the co-chair of the UM Committee and shares responsibility with the Lead Physician Utilization Management Advisor (PUMA) co-chair for the administration of the activities and decisions of the UM Committee, which reports up to the Inpatient Steering Committee and the Quality Board. The UM NM is directly supervised by the Chief of Quality and Patient Safety (QPS), who provides the administrative supervision and general instruction, oversees, and evaluates work product, approves leave and completes performance evaluations. The duties and recommendations of the UM NM can lead to changes in organizational structures, staffing levels and assignments, and policy. This is a non-bargaining unit position. The UM NM is qualified by education and experience to provide direct staff support to Senior Leadership, Service Line Leaders, and others in the planning, designing, integrating, implementing, modifying, and evaluating the effectiveness of program components and/or services to improve the quality of patient care and the appropriateness and timeliness of services provided. Recommendations from the UM Manager on the cost effectiveness and efficiency of programs have a directly impact on policy and alignment of resources, including staffing. The UM NM will independently supervise the UM personnel in section, service line, and facility utilization management activities. This responsibility includes development of performance standards, writing functional statements and position descriptions, evaluating work performance, counseling of employees whose performance is marginal or unsatisfactory, initiating disciplinary actions when necessary. Hears and resolves complaints from employees. The UM NM makes program and facility specific decisions that reflect the distinct and contributory role of nursing; is responsible for providing clinical and administrative recommendations relative to programs, committees, and/or services that relate to Utilization Management; and is a member of the team involved in Performance Improvement (PI), as an approach to assess and improve the quality of healthcare services, including utilization of resources. The UM Nurse conducts analyses of the cost/value of clinics and programs, which can lead to recommendations that affect the distribution of resources, include staffing levels and assignment, and the use of fee or contract employees. The UM NM will serve as the NUMI Administrator. Designated first-line supervisory authority, responsibility, and accountability for Utilization Management Program, ensuring that subordinate personnel provide timely review which complies with generally accepted standards of practice. This includes the all the following functions: 1) Planning work to be accomplished by subordinates, setting priorities, and preparing schedules for completion of work 2) Assigning work to subordinates based on priorities, selective consideration of the difficulty and the requirements of the assignments, and the capabilities of subordinates 3) Evaluating the performance of subordinates. 4) Giving advice, counsel, or instruction to subordinate personnel on work and administrative matters 5) Hearing and resolving complaints of subordinates and referring more serious complaints not resolved to higher level supervisors 6) Recommending and/or taking disciplinary action where appropriate 7) Identifying developmental and training needs of subordinates and providing or making provision for such development and training (VA Handbook 5007, Part III, Chapter 8). 8) Performs other duties as assigned to meet the needs of the Quality and Patient Safety Service, Veterans, and the organization. Responsible for performance improvement data, patient, and employee safety, interviewing applicants, employee relations, standards of care and practice, the work environment, and accreditation and regulatory standards. 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 thru Friday, 8-hour variable shifts between 7:00 am and 6:30 pm Travel: 25% or Less Compressed/Flexible: Not Available Telework: Not Authorized Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required Requirements Conditions of Employment 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. You may be required to serve a probationary period. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. 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). Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) – See “Additional Information” below for details. Qualifications Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate 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); OR Individuals attending a master’s level bridge program in nursing who have completed coursework equivalent to a bachelor’s level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validati
