The Utilization Management (UM) reviewer works within the department of Quality, Safety, and Improvement Service conducting admission and continued stay reviews as required by directive and clinical reviews based on medically approved criteria to determine necessity of admission, length of stay, and discharge planning and tracks, trends, and analyzes data related to patient flow, ensuring veterans receive the right care, at the right time, in the right setting, for the right reason. Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. 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. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), 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 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). The approving official may authorize a waiver of the requirement for ACEN or CCNE accreditation of any degree in nursing provided the college or university has regional accreditation from an accrediting body recognized by the Department of Education at the time of the candidate's graduation and the composite qualifications of the applicant warrant such consideration. 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: 3-5 years RN experience with evidence of advanced clinical knowledge, critical thinking and progressive leadership. Experience in Utilization Managements or Case Management with familiarity with InterQual criteria. Proficiency with Microsoft Office Suite (i.e. Excel, Word, PowerPoint, Outlook) and other VA web-based applications Effective and professional verbal and written correspondence skills, ability to communicate with Veterans, staff, leadership and other stakeholders Experience completing detail-oriented tasks and impromptu assignments Ability to work with minimal to no supervision and as part of a multi-disciplinary team Effective prioritization skills to manage multiple ongoing tasks Ability to maintain strict confidentiality 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 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years 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 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. 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: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. Potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. Transferring patients and objects may be required. ["VA offers a comprehensive total rewards package: VA Nurse Total Rewards Duties include, but are not limited to, conducting concurrent medical record reviews, applying clinical knowledge and evidence-based criteria to evaluate the appropriateness of care provided, interpreting, applying and entering data into National Utilization Management Integrated software, communicating with residents, attendings and NPs at regular intervals throughout the hospitalization and developing effective working relationships, assisting team in appropriate utilization of services and desired patient outcomes by seeking clarification and giving recommendations as appropriate, actively participating in interdisciplinary care rounds and/or conferences to review treatment goals, optimizing resource utilization and participating in discharge planning and evaluating clinical outcomes of nursing practice and elevating issues via the appropriate channels, such as patient safety or peer review, as needed. 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, 10:30 am - 7:00 pm (subject to change based on the needs of the facility) Telework: Not Available Virtual: This is not a virtual position. Recruitment Incentive: May be authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required"]

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