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Registered Nurse - Utilization Management - San Antonio, Texas - Manager

Company: Audie L. Murphy Memorial VA Hospital
Location: San Antonio
Posted on: January 27, 2023

Job Description:

Registered Nurse - Utilization Management - San Antonio, Texas
Duties

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 command.
  • Interprets federal regulations, VHA guidelines, medical review criteria, utilization management processes, clinical documentation requirements, current standards of care, and compliance guidelines.
  • 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.


    Pay:

    Paid Time Off:

    Retirement:

    Insurance:

    Licensure:


    Work Schedule:

    Telework:

    Virtual:

    Relocation/Recruitment Incentives:

    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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