VA Greater Los Angeles Healthcare System (VAGLAHS) is seeking to hire experienced Registered Nurses to work in our Utilization Management (UM) Program. Incumbents are expected to perform assessing, planning, coordinating, guiding and collaborating with acute care hospital services. Possessing knowledge of evidenced-based clinical criteria. Functioning as an inpatient care coordinator, pertaining to patient flow. Responsible for focused studies of utilization patterns for the facility.
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 validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). 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. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Preferred Experience: BSN and/or MSN preferred Utilization Management experience preferred Experience in the application of InterQual criteria, use of NUMI database, and programs like CERNER. Inpatient case management experience preferred Minimum of 5 years of successful nursing practice, encompassing education, administration, leadership and Quality Management Performance Improvement (QM/PI) experience preferred. Basic computer literacy proficiency with the use of Microsoft Office programs or comparable word processing, spreadsheet and graphic software and the ability to learn new programs specific to the VA preferred. Ability to work variable and flexible tours to meet program demands Demonstrated ability to accurately implement VA GLA policies, regulations, standards of care and standards of practice preferred. Demonstrated ability to review patient clinical records and extract needed information. Proven ability to facilitate group problem solving preferred. Excellent organizational, communication, writing, and time management skills preferred. Excellent interpersonal skills and the ability to work independently as well as collaboratively with multiple service lines and disciplines preferred. Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12754414. Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies. An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required. Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex. An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required. Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience. Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience. Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting. MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III. *Note: Foreign education programs/degrees are not creditable as related degrees. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Physical Requirements: Heavy lifting (45 lbs and over); Heavy carrying (45 lbs and over); Straight pulling and pushing; reaching above shoulder; use of fingers; both hands required; walking and standing up to 8 hours; repeated bending; Ability for rapid mental and muscular coordination simultaneously; hearing aid permitted.
Job duties include, but are not limited to, the following: Demonstrates ability to perform a wide range of Utilization Management/Quality Management/Performance Improvement (UM/QM/PI) activities that impact patient care and organizational outcomes. Reviews, analyzes and applies existing internal and external regulatory standards, and Professional Organization Guidelines. Develops measurement tools and pulls reports, which assist in efficient and accurate data collection. Uses a systematic approach to gather and evaluate data and patterns of utilization regarding quality of care issues to improve outcomes consistent with the organization's goals and objectives. Performs chart reviews, focused studies as assigned, duties in an independent manner with little or no direct supervision. Serves as a consultant on Utilization Management and Performance Improvement Initiatives. Assists with the organization's meeting of Utilization Management performance measures, by providing management, with educational sessions as needed, collecting data for focused evaluations and process improvement teams, preparing data analysis and reports for assigned committees at least quarterly. Performs at least two Utilization Management in-services/workshops annually, arranging for and conducting in-service education to physician staff regarding content of the educational sessions. Triage patient care to a level of clinical appropriateness based on InterQual. Researches, interprets, identifies, develops and presents formal and informal educational programs for health professionals and support services that include (New Employee Orientation, Nursing Orientation, Resident Orientation etc.) regarding UM. Establishes effective collegial relationships with appropriate professional organizations in the larger health care community on a local, state and national basis. Demonstrates thorough knowledge of InterQual criteria and their application. Collaborates with the Interdisciplinary Team and Hospitalist (PUMA). Collaborates admissions as an admission screening nurse. Able to verbalize process of admission. Demonstrates proficiency in the National Utilization Management Integration (NUMI) web-based application and Bed Management Solution (BMS) web-based tool for tracking bed availability, patient movement and flow management. Responsible for reviewing all inpatient cases after admission, conducting continued stay reviews. Providing inpatient case management coverage as assigned. Performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs. 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: 7:00am-3:30p variable tours/shifts, including weekends and holidays Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Duty Location: 11301 Wilshire Blvd, Los Angeles, CA 90073