The New Mexico VA Health Care System is seeing a Registered Nurse (Utilization Review-Utilization Management) to join the team! Duties include but not limited to the following: He/she must possess the ability to interact with a wide variety of employees and to work independently in accomplishing assignments and program goals. Utilizing the National Utilization Management Integrated software he/she provides level of care recommendations upon admission, internal movements, and continued stays. Works in collaboration with clinical and administrative staff that are engaged in access and patient flow. The UM RN utilizes best standards of practice and adheres to the guidelines of InterQual Acute Care guidelines, The Joint Commission and established benchmarks. The UM RN collects, analyzes and reports aggregate data, identifies opportunities for improvement and works collaboratively with all disciplines to develop and implement effective strategies to improve performance, improve quality of care, minimize risk, and ensure effective utilization of resources. The UM RN will continuously assess, monitor and evaluate care based on the established guidelines as per McKesson InterQual Criteria. These activities include to support all areas of nursing and healthcare including, but not limited to, the direct provision of care, establishing effective administrative systems, managing and delivering educational experiences, enhancing lifelong learning, and supporting nursing research. Responsible for conducting concurrent medical record reviews using specific indicators and criteria approved by the medical staff; interpreting, applying and entering data into National Utilization Management Integrated software; promoting effective and efficient utilization of clinical resources; mobilizing resources as needed to achieve expected goal within the desired timeframe; conducting reviews for appropriate utilization of services from admission through discharge; assess patient care required throughout the continuum of care for diagnosis, procedures and DRG's; communicating with PUMA at regular intervals throughout the hospitalization and develops effective working relationships; assisting physicians in maintaining appropriate cost, care and desired patient outcomes; participating in interdisciplinary care rounds and/or conferences to review treatment goals, optimize resource utilization and to recommend alternate levels of care when acute care is no longer needed; assisting in providing direction and participating in the development and implementation of policies and protocols in order to provide advice and guidance in managing special cases or meeting patient needs. Work Schedule: Rotating Shifts; will be discussed during the interview process. Telework: Not Available. Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized. Permanent Change of Station (PCS): Not Authorized. Financial Disclosure Report: Not required.
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.