Utilization Management Registered Nurse

This position is located within the Nursing Service at the James A. Haley Veterans' Hospital in Tampa, Florida. The Utilization Management (UM) Nurse within the Quality Management Service Line. The incumbent provides clinical review, utilization oversight, and supports the organization's mission by ensuring Veterans receive care in the appropriate setting based on evidence-based criteria.

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/12961507

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:

• Utilization Management (UM) in VA Healthcare plays a critical role in helping the VA manage and control healthcare costs by preventing the overuse, misuse, or underuse of medical services. By reducing unnecessary or redundant medical procedures and promoting cost-effective treatments, UM enables the VA to manage its budget more effectively.
• Effective UM ensures the optimal use of limited healthcare resources, including hospital beds, medical tests, and medical equipment (such as CT and MRI scanners). Through careful review and guidance, UM advises on the appropriate level of care for each patient, helping to ensure that Veterans receive the right care at the right time. This approach minimizes unnecessary delays and waste, allowing more Veterans to access the care they need.
• By prioritizing efficient and effective resource allocation, UM supports the VA's mission to deliver high-quality healthcare to Veterans, maximizing the impact of available resources and improving overall patient outcomes

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. The work is primarily sedentary but may require periods of walking, standing, bending, and lifting light items such as papers, office materials, or medical records. The incumbent must be able to sit for prolonged periods while reviewing medical documentation and operating a computer. Occasional travel within the medical center and to affiliated sites may be required. The position demands the ability to concentrate, analyze information, and work effectively under pressure with multiple deadlines. The incumbent must demonstrate emotional and mental stability to perform the essential functions of the position and interact professionally with patients, staff, and interdisciplinary teams.

Responsibilities:

The Utilization Management Nurse functions within the Quality Management Service Line, performing clinical review, assessment, and coordination activities that support appropriate levels of care for Veterans. The incumbent applies evidence-based criteria to evaluate the medical necessity, timeliness, and efficiency of healthcare services. Working collaboratively with interdisciplinary teams, the nurse helps ensure resources are used effectively and that Veterans receive high-quality care aligned with VA policies, regulatory standards, and clinical guidelines. This position supports continuous performance improvement, regulatory compliance, and optimal patient flow across the medical center.

The major duties of this position include, but are not limited to:

- Conducting concurrent, retrospective, and prospective utilization reviews to determine the appropriate level of care and medical necessity across inpatient services.
- Applying standardized utilization management criteria and clinical judgment to assess treatment plans, diagnostic testing, and hospital admissions or continuations of stay.
- Monitoring for overuse, underuse, or misuse of services and communicating identified concerns to providers, care teams, and leadership for timely resolution.
- Coordinating with interdisciplinary teams to address barriers to care, promote timely transitions, and ensure Veterans receive the right care at the right time.
- Documenting UM, findings and recommendations accurately and consistently in accordance with VA and facility guidelines.
- Preparing, analyzing, and presenting utilization data and trends to support quality improvement, performance measures, and organizational decision-making.
- Supporting compliance with Joint Commission standards, VHA directives, and other regulatory requirements related to utilization management and resource stewardship.
- Participating in committees, workgroups, and initiatives related to UM, performance improvement, patient flow, and quality management.

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: Monday - Friday, 0730-1600. Flexibility may be required based on operational needs.
Telework: Not Available
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized

Salary : $78,737