Utilization Management RN — Elevate Care with Data & Education

US-Department-of-Veterans-Affair; Tucson (AZ); On-site; USD 80,000 - 100,000; Full time

Job summary

The Utilization Management RN at the US-Department-of-Veterans-Affair provides evidence-based nursing practices using UM criteria to perform complex reviews. Responsibilities include data collection and analysis, provider education, and collaboration on level of care decisions and treatment plans.

InterQual reviews are conducted for prospective, observation, admission, and ongoing stay patients. The role emphasizes compliance with qualification standards and licensing requirements for

Qualifications

• English language proficiency is required for direct patient care.
• Graduate of a school of professional nursing with ACEN/CCNE accreditation or equivalent.
• Current, full, active, and unrestricted nursing license in the U.S. or District of Columbia.

Responsibilities

• Collect, analyze, and report data related to utilization management.
• Provide provider education based on UM criteria.
• Collaborate with care teams on level of care determinations and treatment plans.
• Conduct InterQual reviews for prospective, observation, admission, and continued stay patients.

Skills

UM review data analysis

Provider education

InterQual reviews

Collaboration with care teams

Education

RN license

Job description

The Utilization Management RN at the US-Department-of-Veterans-Affair provides evidence-based nursing practices using UM criteria to perform complex reviews. Responsibilities include data collection and analysis, provider education, and collaboration on level of care decisions and treatment plans.

InterQual reviews are conducted for prospective, observation, admission, and ongoing stay patients. The role emphasizes compliance with qualification standards and licensing requirements for