Utilization Management Nurse Manger

Veterans Health Administration • New Orleans, LA

10d • Onsite

About The Position

The Utilization Management (UM) Nurse Manager functions as a generalist at the point of care for an assigned service. The manager consults with other units on individual patients, provides in-services on utilization management and patient flow, and educates staff based on documented best practices. The role collaborates with clinical leaders across the health care system to develop evidence-based standards of care.

The UM Nurse Manager develops and participates in unit quality improvement projects, implements quality improvements, and documents outcomes at the program or service level. The position leads and organizes care delivery to support continuity, peer accountability, access to care, and discharge planning. It applies advanced clinical judgment to involve staff in planning, decision-making, and outcome evaluation; functions as an expert in clinical practice and assigned areas; evaluates current practice and organizational processes; and uses professional standards, scientific evidence, and practice to evaluate programs and services.

The manager attends daily interdisciplinary meetings and assigned staff, national, or VISN meetings, and completes additional projects as requested by the Chief. Duties also include monitoring Inter-Facility Consults (IFC) for patient scheduling, overseeing arrangements for traveling Veterans’ accommodations and needs, and using the National Utilization Management Integration (NUMI) tool to review clinical data and ensure subordinate staff deliver efficient, high-quality care.

The position is not virtual. Telework is ad hoc only. The Monday–Friday work schedule is 7:30 a.m.–4:00 p.m. and may change based on facility needs. Relocation and recruitment incentives and permanent change of station are not authorized.

Requirements

• Proficiency in basic written and spoken English.
• Graduation from an appropriately accredited school of professional nursing, or qualifying equivalent education as described in the posting.
• Current, full, active, and unrestricted registered professional nurse licensure in a U.S. State, Territory, Commonwealth, or the District of Columbia.
• Meet the education and experience criteria for the applicable Nurse grade and level.
• U.S. citizenship; non-citizens may be appointed only when qualified U.S. citizens cannot be recruited in accordance with VA policy.
• Pass a pre-employment physical evaluation.
• Complete required background/security investigation and online onboarding.
• Submit acceptable identification for pre-employment requirements.
• Participate in the seasonal influenza vaccination program.
• Male applicants born after December 31, 1959, must be registered with Selective Service.
• Applicants tentatively selected for a testing-designated position must undergo urinalysis for illegal drug use.

Nice To Haves

• Advanced use of and experience with InterQual and NUMI, and patient flow experience; the posting states this experience is required.
• NUMI and patient flow expertise within a medical center and experience serving as the primary point of contact for utilization management matters.
• VA nursing leadership experience.
• Case management experience.
• Detail orientation, data analytics and reporting experience, and experience monitoring Inter-Facility Consults for patient scheduling.

Responsibilities

• Provide consultation to other units regarding individual patients.
• Provide in-services on utilization management and patient flow.
• Educate staff using documented best practices.
• Collaborate with clinical leaders across the health care system to develop evidence-based standards of care.
• Develop and participate in unit quality improvement projects and implement quality improvements.
• Document outcomes at the program or service level.
• Lead and organize care delivery to support continuity, peer accountability, access to care, and discharge planning.
• Use advanced clinical knowledge and judgment to involve staff in planning, decision-making, and evaluating outcomes.
• Function as an expert in clinical practice and assigned areas of responsibility.
• Systematically evaluate current practice and formulate outcomes for patient groups or organizational processes.
• Use professional standards of care, scientific evidence, and practice to evaluate programs and service activities.
• Attend daily interdisciplinary meetings and assigned staff, national, or VISN meetings.
• Complete additional projects as requested by the Chief.
• Monitor Inter-Facility Consults for patient scheduling.
• Oversee arrangements for traveling Veterans’ accommodations and ensure their needs are met.
• Use the NUMI tool to evaluate clinical review data and ensure subordinate staff perform at optimal levels while maintaining efficient care.

Benefits

• Competitive salary, regular salary increases, and potential performance awards.
• 50 days of paid time off per year: 26 days of annual leave, 13 days of sick leave, and 11 paid federal holidays.
• Traditional federal pension with five-year vesting.
• Federal 401(k) with up to 5% in contributions by VA.
• Federal health, vision, dental, term life, and long-term care insurance; many federal insurance programs can be carried into retirement.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree