Utilization Management Director jobs in Temple, TX

Duties

The Utilization Management Practitioner (UMP) Registered Nurse is responsible for the ongoing development and maintenance of a continuous readiness program which ensures facility accreditation and compliance with external accrediting standards and internal performance expectations as delineated in VHA guidelines and directives. The UMP will provide guidance within an enterprise risk management framework, driving improvement and developing processes which support safe and efficient patient care delivery. Achievement of these responsibilities will require strong skills in the leading of both large and small interdisciplinary groups seeking system systems improvement outcomes, teaching, writing, chart review, data extraction, evaluation and trending, electronic data reporting, priority-setting, and critical thinking skills. The UMP must have knowledge of evaluation techniques and their application to the CTVHCS setting, including general knowledge of processes utilized in problem identification, prioritization, analyses, leading change, displaying data to facilitate understanding of potential/actual issues, translating data into information, research, data mining, and program evaluation.

The UMP will possess thorough knowledge and competence of InterQual Evidence-based Clinical Content solution, management process, clinical documentation requirements, current standards of care, federal and regulatory requirements, and compliance guidelines for optimizing care management. Accountable for utilizing critical thinking skills and sound judgement to ensure positive outcomes, maximizing third-party collections, and delivering quality patient care performance improvement activities. The UMP provides guided decision support for the transitioning of patients throughout the care patient flow process. Demonstrates knowledge and ability to apply principles of evidence-based practice. Works independently with minimal supervision, exhibits sound decision-making and organizational skills, and has the ability to set priorities. Assumes direct responsibility in the review and analysis of the facility length of stay, cost per case and utilization compliance on a continual basis. Provides support at the unit level, the service level, the organizational level, and work areas assigned to meet the needs of CTVHCS. Completes other assignments as delegated by the UM Nurse Manager.

The UMP is responsible for coordinating, developing, executing, monitoring, and evaluating all UM activities. Activities encompass utilization review, resource management, coordination of care, transition/discharge planning, and across the board episodes of care. The UMP promotes and facilitate patient movement throughout the healthcare continuum with the development and implementation of processes and procedures that ensures timely and proactive guidance to case manager and social worker interventions. The UMP conducts UM Reviews assessments for appropriateness of admission, continued stay and to facilitate and expedite discharge of patients using established criteria. Facilitate the initiation of diagnostic series, treatment, planning, and therapeutic treatment. Collaborates with social workers on referrals to alternate levels of care, ensuring appropriate utilization of resources to improve the quality of patient care. The UMP identifies patients and families who have complex, psychosocial, financial, and/or legal needs, referring them to correct resources and management teams. Collaborates with Physician Advisor's coordinates plans of care, develops clinical practice guidelines and critical pathways and assists is facilitating communication with the IDT other case managers and Utilization Management staff.

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: Rotating Shifts including weekends
Telework: Available per Facility Policy
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
Financial Disclosure Report: Not required

Requirements

Conditions of Employment

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• Selective Service Registration is required for males born after 12/31/1959.
• Must be proficient in written and spoken English.
• You may be required to serve a probationary period.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process.
• Must pass pre-employment physical examination
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details.

How You Will Be Evaluated

• Benefits

  A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

  Review our benefits

  Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

• Required Documents

  As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

  To apply for this position, you must provide a complete Application Package which includes:
  

  • License
  • Resume
  • Transcript

  
  
  The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), etc.
  

  • Cover Letter
  • DD-214/ Statement of Service
  • Disability Letter (VA)
  • License
  • Other Application Documentation
  • VA Application 10-2850a (Current within 90 days)
  • Other (3)
  • Other (4)
  • Other (5)
  • PCS Orders
  • Performance Appraisal
  • Professional Certification
  • Proof of Marriage Status
  • Resume
  • SF-15
  • SF-50/ Notification of Personnel Action
  • Transcript

  
  
  Veterans' Preference Note: Preference eligible candidates and other Veterans will be given preference when qualification of candidates are approximately equal for Title 38 positions in VHA. When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.

  If you are relying on your education to meet qualification requirements:

  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. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

  Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

• How to Apply

  All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 01/29/2024 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12277925.

  • To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.

  • Click Submit My Answers to submit your application package.

  NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
  
  To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.

  Agency contact information

  VISN 17 SSU USAS Group

  Email

  VISN17SSUUSAS@va.gov

  Address

  VA Central Texas Health Care System
  1901 Veterans Memorial Drive
  Temple, TX 76504
  US

  Next steps

  Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.
  
  You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
  
  NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.

• Fair and Transparent

  The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

  • Equal Employment Opportunity (EEO) Policy
  • Reasonable accommodation policy
  • Financial suitability
  • Selective Service
  • New employee probationary period
  • Signature and false statements
  • Privacy Act
  • Social security number request

Required Documents

Clarification from the agency

Open to US Citizens