The Utilization Management Case Manager is assigned to the Inpatient and Emergency Services Division of Portland VA Medical Center. The Utilization Management (UM) Case Manager is a professional RN with advanced skills and sophisticated knowledge of patient treatment and care planning across the patient care continuum, and has experience in a variety of clinical settings/levels of care. The UM Case Manager functions as a reviewer of patient admissions and continued stay hospital days as a member of the interdisciplinary team. The UM Case Manager assesses, plans, implements and evaluates the care of hospitalized patients applying lnterQual criteria using the designated computer-based format. The UM Case Manager refers variances for secondary review and to the Physician Advisor for approval. The incumbent prepares reports/graphs as needed. The UM Case Manager participates in the designated Inter-Rater Reliability process. The Utilization Management Case Manager applies advanced interpersonal communication, evidence-based knowledge, and clinical expertise to guide the interdisciplinary team in the appropriate use of clinical services and to enhance the continuity of care and process improvement. S/he attends interdisciplinary discharge planning rounds. The incumbent demonstrates all mandatory organizational and clinical competencies required for this position. The UM Case Manager supports the Access Office role as needed to assist coverage of the phones and/or processing faxes. Work Schedule: Monday - Friday 07:00 am - 3:30 pm; 2:00 pm - 10:30 pm Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.