The Quality Management Utilization Review Consultant Registered Nurse delivers knowledge-based care to assigned clients while developing technical skills. 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.
Duties include but not limited to: Conducts regular review of the patient's medical record and other documents. Ensures that the admission and continued stay process follows utilization review guidelines. Meets with UM team on UM matters. Meets, trains and consults with medical center staff on appropriate UM matters and applies established InterQual criteria for reviews. Works in teams and one on one with various levels of clinical staff to improve care delivery.
Works closely with a variety of healthcare professionals, clinical services, internal and external services, and community agencies to provide efficient and effective health care using the appropriate resource management criteria. Acts on behalf of the Veteran to assure the necessary clinical services are received and that progress is made. Works with other UM nurses and discharge planning staff to support interdisciplinary care planning and discharge planning.
Collaborates with medical and nursing staff in reviewing length of stay, discharge criteria, track trends, and analyzes UM data. Actively communicates with UM leadership and PUMA on UM issues and provides information and data to the Pt. Flow Committee. Performs specialty study reviews as needed related to patient care and utilization. Maintains up to date training required for NUMI.
May be required to cover RN Case Manager duties and therefore must maintain any training required for this purpose. Collects data, monitors staff compliance with relevant policies, directives, and standards. Provides reports detailing trends and provides direct staff support to all services in planning, designing, integrating, implementing, modifying, and administering a comprehensive qualify management program area.
Participates in facility councils, committees, and work groups.
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.
Flexible to meet the needs of the organization. Compressed/Flexible: Not Authorized. Telework: Ad-hoc. Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized. Permanent Change of Station (PCS): Not Authorized.
eduardo.crespo@va.gov · 904-761-0911
This position is with Veterans Health Administration, Department of Veterans Affairs.
The posted pay range is $72273 – $148502/yr.
This position is eligible for telework.
Applications close on 2026-09-14.
This position is open under the 'Fed Internal Search' hiring path.
Source: USAJOBS.gov — U.S. Federal Government
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