Registered Nurse - Utilization Management - San Antonio, Texas - Manager
Company: Audie L. Murphy Memorial VA Hospital
Location: San Antonio
Posted on: January 27, 2023
Registered Nurse - Utilization Management - San Antonio,
VA offers a comprehensive total rewards package:
The RN Utilization Management position is at the VA in San Antonio.
The RN is responsible for utilizing evidence based InterQual
criteria to conduct prospective, concurrent, and retrospective
reviews using the National Utilization Management Integration
database. The RN will work predominately in the emergency
department to assess and collect health data based on this criteria
and makes recommendations to the provider on the most appropriate
level of care for the patient and determine if the patient meets
medical necessity for the hospital stay.
- Responsible for utilizing InterQual criteria and conducts
InterQual reviews using the National Utilization Management
Integration database, successfully passes the Inter-Rater
reliability exams annually.
- Assesses and collects health data based on the InterQual
criteria and communicates to an interdisciplinary team, developing
plans for those patients not meeting InterQual Criteria and noting
the right level of care.
- Monitors admission and continued stay criteria identifying
potential process deficiencies, makes suggestions for improvement,
and reports discrepancies through the appropriate chain of
- Interprets federal regulations, VHA guidelines, medical review
criteria, utilization management processes, clinical documentation
requirements, current standards of care, and compliance
- Demonstrates leadership in delivering and improving holistic
care for Veterans through collaborative, courteous, timely, patient
centered communication with all medical disciplines within the
South Texas Veterans Health Care System.
- Serves as a resource person and serve as a consultant for
problem solving nursing and organizational issues.
- Identifies trends and develops actions plans and/or
participates in service or organizational projects to improve
services with measurable, sustainable outcomes. Participates in
Nursing Service and medical facility committees.
Paid Time Off:
Permanent Change of Station (PCS)
Financial Disclosure Report:
Keywords: Audie L. Murphy Memorial VA Hospital, San Antonio , Registered Nurse - Utilization Management - San Antonio, Texas - Manager, Executive , San Antonio, Texas
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