Registered Nurse - Purchased Care

Duties

The Registered Nurse (RN) Case Manager in Purchased Care Section of Administrative Medicine Service is responsible for clinical case management and utilization review activities necessary to purchase patient care in the community and meet the Medical Center's utilization goals in a manner that successfully integrates the community care with past and future VA Care. The incumbent works collaboratively with all clinical services across the Medical Center. In addition, he/she works collaboratively with the administrative staff within the Purchased Care Program to ensure coordinated, timely, cost-efficient care to the Veteran while maintaining customer satisfaction. The RN Case Manager frequently acts on behalf of PVAHCS with other VISN facilities to determine availability of clinical services, ensure proper transfer of patient care, participate in collaborative case management planning, utilization review, discharge planning, and other related case management activities including the review of outside medical services based on established guidelines and medical necessity. This includes but is not limited to:

• Clinical coordination of the Veterans Choice Program
• Consult review and approval of secondary authorization requests
• Coordinating care with outside vendors, contracts, and PC3 TriWest staff
• Monitoring of patients hospitalized in non-VA facilities
• Coordination of care for the patient with the VA referring provider and the community provider
• Collaboration with the authorization staff to maintain fiscal responsibility and efficiency
• Integrating the patient back into the VA system when purchased care episode is complete
• Consult management duties including consult closure
• Transfer Coordination
• Utilization Management duties utilizing InterQual criteria
• Discharge Planning
• Back-up for Inter and intra-facility transfers, Traveling Veteran Coordination, and Transplant Coordination

The RN Case Manager will be assigned a primary focus, but will also act as backup for other roles including consult care management, inter- and intra-facility transfers, admission and concurrent utilization review/utilization management activities, and Traveling Veteran Coordination and Transplant Coordination. The incumbent will act as a resource to the medical center staff, contract and networking facilities. The incumbent will be assigned to Purchased Care under the Administrative Medicine Service for the Chief of Staff.

PREFERRED EXPERIENCE:
2 years of successful nursing practice AND knowledge in case management, utilization review, and/or purchased care concepts.

PREFERRED EDUCATION:
Bachelor of Science in Nursing.

Work Schedule:
Monday through Friday, 8:00 AM to 4:30 PM; may include rotating days off, rotating tours of duty, and weekend and holiday coverage. Shifts are subject to change.

Position Description Title/PD#:
Staff Nurse Functional Statement- Purchased Care

Relocation/Recruitment Incentives:
Not authorized

This announcement will be used to fill Utilization Review and NVCC Consults.

Qualifications

BASIC REQUIREMENTS:

• Citizen of the United States.
• Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The National League for Nursing Accrediting Commission (NLNAC) or The Commission on Collegiate Nursing Education (CCNE).
• 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. In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing.
• Must be proficient in spoken and written English.
• Must be able to perform the Physical Standards of the position.

GRADE DETERMINATIONS:
In addition to the education and experience as listed below, the RN must also have an acceptable level of quality in order to obtain the grade level below. This will be determined by the Nurse Professional Standards Board.

• Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, no experience.
• Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of experience, or an ADN or Diploma in Nursing and a bachelor's degree in a related field and no experience; or a Bachelors of Science in Nursing (BSN) and no experience.
• Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of experience, or an ADN or Diploma in Nursing and a bachelors degree in a related field and approximately 1-2 years of experience; or a BSN with approximately 1-2 years of experience, or a Master's degree in nursing (MSN) or related field with a BSN and no experience.
• Nurse II - A BSN with approximately 2-3 years of experience, or ADN or Diploma in Nursing and a bachelors degree in a related field and approximately 2-3 years experience or a Master's degree in nursing or related field with a BSN and approximately 1-2 years experience, or a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no experience.
• Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years experience or Doctoral degree in nursing or related field and approximately 2-3 years experience.

Applicant's education and length of nursing practice (experience) will be considered by a Nurse Professional Standards Board in determining the grade and salary of the applicant selected. Experience as a RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following four dimensions of nursing: Practice, Professional Development, Collaboration and Scientific Inquiry. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel. The criteria are as follows: Practice: practice, ethics and resource utilization, Professional Development: performance, education/career development, Collaboration; collaboration, collegiality, Scientific Inquiry: quality of care, research.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

PREFERRED QUALIFICATIONS:
The following education and experience is highly desired:

• Bachelor of Science in Nursing (BSN).
• 2 years of successful nursing practice AND knowledge in case management, utilization review, and/or purchased care concepts.
• Demonstration of a high degree of personal and professional accountability, maturity, stability and the ability to be self-directed, function independently and work effectively with others at all levels in the organization.
• Demonstration of the ability to communicate effectively and efficiently coordinate patient care activities with the interdisciplinary team.
• Demonstration of excellent customer relations skills in previous assignments.
• Demonstrated skills in problem-solving, applying critical thinking skills, flexibility, and resolving conflict.
• Demonstration of involvement in performance improvement activities and a willingness to initiate and participate in unit-based/service-based quality improvement initiatives to improve patient care and customer satisfaction.
• Possess basic computer knowledge and skills with proficiency in preparing reports/documents.

Note:
The full performance level of this vacancy is Grade III. The actual grade at which an applicant may be selected for this vacancy is in the range of I to III. The Nurse Professional Standards Board (a peer-review group) will review the selected candidate's education and experience and recommend the grade, level (if applicable), and step at which the candidate will be placed. The salary is based on the grade, level (if applicable) and step approved for the selected candidate.

VA encourages persons with disabilities to apply. The health related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.
References: VA Handbook 5005, Part II, Appendix G6, NURSE QUALIFICATION STANDARD.

Education

PLEASE NOTE:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement.) Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website:
All education claimed by applicants will be verified by the appointing agency accordingly. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education.
Nursing education must be accredited by The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). You can verify your education accreditation at the following links:

• American Association of Colleges of Nursing, Commission on Collegiate Nursing Education.
• Accreditation Commission for Education in Nursing.