Summary

The Western New York Healthcare System is seeking a Utilization Management (UM) Registered Nurse (RN) to work at its Buffalo Location. The Nurse Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership - experience - and creative approaches to management of complex utilization processes.

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/12733997
• 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: BSN Five years RN clinical experiences in a variety of settings
• Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: The physical requirements of this position include lifting - prolonged standing and sitting - frequent bending - walking (distance) - climbing - reaching (overhead - extensive/repetitive) - pulling - pushing - repetitive motion and stooping
• The mental/sensory requirements include recall - reasoning - problem-solving - hearing - speaking clearly - writing legibly - keyboarding - reading and logical thinking - depth perception - hearing (aide permitted)
• near/far vision correctable to meet Driver's License requirements
• The environment's pace can vary from steady to a sometimes-fast pace requiring handling of multiple priorities - frequent - sometimes intense customer interactions - and the ability to adapt to frequent changes in a sometimes-noisy environment
• There may be the need to use personal protective equipment to prevent exposure to disease - illness and hazardous materials
• Work requires extensive walking - standing - stretching and bending in caring for patients.

Duties

• The Nurse Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership - experience - and creative approaches to management of complex utilization processes
• Practical experience in the application of UM methods and expertise in medical necessity review criteria
• This position requires strong analytical skills and the ability to evaluate program structure - process - and effectiveness and recommend strategies for program improvement
• Duties include: Responsible for participating in field UM program review activities and providing advanced clinical and administrative recommendations and consultation to local and VISN UM staff
• Evaluates program structure - process - and effectiveness and recommend strategies for program improvement
• Possesses comprehensive knowledge of clinical appropriateness - functions - processes - and principles of utilization management
• Instructs UM staff in medical necessity criteria and interact with all levels of clinical and administrative leadership across the facility
• Serves as a resource to help UM programs analyze and display UM outcomes to highlight quality and efficiency improvement opportunities Guides system improvement in process and resource use at the local and network level
• Responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care
• Assesses - plans - implements - and evaluates care based on age specific components
• Assumes responsibility for the coordination of care focused on patient education - self-management - and customer satisfaction throughout the continuum of care
• Follows procedures per established policies and guidelines
• Influences care outcomes by collaborating with members of the interdisciplinary team
• Executes position responsibilities that demonstrate leadership - experience - and creative approaches to management of complex client care
• 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 - 7:30AM to 4:00PM Virtual: This is not a virtual position
• Permanent Change of Station (PCS): Not Authorized