Registered Nurse - Utilization Management Discharge Nurse

Veterans Health Administration, Department of Veterans Affairs; Seattle (WA); On-site; USD 90,000 - 120,000; Full time

Job summary

The Veterans Health Administration is seeking an Utilization Management Discharge Nurse in Seattle to apply nursing process and review criteria to determine medical necessity for inpatient admissions and continued stays. You will coordinate safe discharges with patients, families, and the treatment team, and collaborate with an interdisciplinary group to optimize care transitions.

This role uses InterQual criteria, emphasizes thorough discharge planning, patient safety, and reducing readmissions

Qualifications

• Graduate of a school of professional nursing approved and licensed in the US.
• English language proficiency for direct patient care per standards.
• Active state nursing license or eligible for temporary appointment and licensure.

Responsibilities

• Reviews inpatient charts using third-party criteria to determine medical necessity.
• Collaborates with providers and the interdisciplinary team to recommend discharge plans.
• Coordinates discharge planning, including DME, home services and outpatient needs.
• Acts as liaison between hospital staff, patients, families and outside facilities.
• Supports performance improvement projects and safe, timely escalations.

Education

RN Nursing Degree (State License)

Nursing Degree Accreditation

Tools

InterQual

Job description

Summary

The Utilization Management Discharge Nurse uses the nursing process and nursing expertise in using review criteria to determine medical necessity for inpatient admissions and continued stays. This nurse will collaborate with patients - family - caregivers - and the treatment team to coordinate safe and effective discharges.

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 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
• 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/13030400
• 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
• Preferred Experience: 3+ years acute inpatient direct patient care Bachelor of Science in Nursing Case Management Experience Utilization Management/Review experience Inpatient discharge planning experience Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/.

Duties

• Duties include but are not limited to: Strong analytical skills and the ability to evaluate program structure - process - and effectiveness while recommending strategies for program improvement
• Reviews inpatient charts - using third party criteria (currently InterQual) - and collaborates with providers and an interdisciplinary team to provide recommendations and consultation
• May refer specific cases to the Physician Utilization Management Advisors (PUMA)
• Excellent fact finding - interpersonal communication - and problems solving skills
• Guides performance improvement projects and initiatives
• Provides guidance regarding the best use of limited resources in a quality health care environment
• Completes annual criteria training and testing requirements
• Collaborates with the interdisciplinary team to coordinate safe and effective discharges Completes tasks necessary in preparation for discharge for example - following required DME - home services - outpatient needs - patient/family plans for discharge - and acting as a liaison between hospital staff and outside facilities
• Collaborates with patients - family and/or caregivers - and healthcare professionals involved in their care
• Coordinates discharge plan with providers - social work - ancillary services - and patient care nurses/units
• Has a proactive approach to reduce readmissions - length of stay - and promotes a smooth transition from the hospital to another care setting
• Includes early identification and assessment to determine barriers to discharge and discharge 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: Full-time
• Some weekend and weekday coverage required
• 10:30 a.m
• - 7:00 p.m
• (There may be flexibility on weekend schedule) Compressed/Flexible: May be authorized
• Telework: Not Available
• Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not authorized
• Permanent Change of Station (PCS): Not authorized.