Utilization Management; UM Registered Nurse; RN

Summary

Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex utilization processes. Practical experience in the application of UM methods and expertise in medical necessity review criteria. This position requires strong analytical skills and the ability to evaluate program structure, process, and effectiveness and recommend strategies for program improvement.

• English Language Proficiency – required for direct patient care positions.
• In accordance with 38 U.S.C. 7403(f) – no person shall serve in direct patient care unless proficient in basic written and spoken English.
• Graduate of a professional nursing school approved by an accrediting agency (ACEN or CCNE) or completion of equivalent requirements.
• Individuals attending a master’s level bridge program in nursing may become registered as a nurse with a state licensing board prior to completion.
• Upon achieving a state license, appointment may be temporary and later converted to permanent upon meeting bridge program requirements.
• (Reference VA Handbook 5005 – Appendix G6)
• Foreign school graduates must have current full active unrestricted registration; required formal equivalency validation for education higher than associate degree.
• Current full active unrestricted registration as a graduate professional nurse in a U.S. state, territory, commonwealth, or District of Columbia.
• Graduate Nurse Technician (GNT) Exception: candidates may be appointed at entry step on a 120‑day temporary appointment while pursuing licensure.
• Grade determinations based on scope, education, and dimension criteria detailed in the online assessment.
• The dimension requirements (practice, veteran/patient driven care, leadership, professional development, and evidence‑based practice/research) are detailed for each grade and level.
• Grade/Level Scope Education
  • Nurse I – Level I:
    Delivers fundamental knowledge‑based care to assigned clients while developing technical competencies.
  • Requires an associate degree (ADN) or diploma in nursing with no additional professional nursing required.
  • Nurse I – Level II:
    Demonstrates integration of biopsychosocial concepts and cognitive skills; provides care to clients with basic or complex needs.
  • Requires an ADN or diploma in nursing and 1 year of specialized nursing experience equivalent to Nurse I – Level I; or a BSN with no additional professional nursing experience.
  • Nurse I – Level III:
    Demonstrates proficiency in practice based on conscious and deliberate planning; self‑directed in goal setting for complex client situations.
  • Requires an ADN or diploma in nursing and 2 years of professional nursing experience (1 year equivalent to Nurse I – Level II); or a BSN and 1 year of professional nursing experience equivalent to Nurse I – Level II; or an MSN or related master’s with a BSN and no additional professional nursing experience.
  • Nurse II:
    Demonstrates leadership in delivering and improving holistic care through collaborative strategies.
  • Requires a BSN with 2 years of professional nursing experience equivalent to Nurse I – Level III; or an MSN with 1 year of specialized nursing experience equivalent to Nurse I – Level III; or a master’s in a related field with a BSN and 1 year of specialized nursing experience equivalent to Nurse I – Level III; or a doctoral degree in nursing or related field with a BSN and no additional professional nursing experience.
  • Nurse III:
    Executes responsibilities that demonstrate leadership, experience, and creative approaches to managing complex client care beyond the immediate practice setting.
  • Requires an MSN with 2 years of specialized nursing experience (1 year equivalent to Nurse II); or a master’s in a related field with a BSN and 2 years of specialized nursing experience (1 year equivalent to Nurse II); or a doctoral degree in nursing or related field with a BSN and no additional professional nursing experience.
• * Note:
  
  Foreign education programs or degrees are not creditable as related degrees.
• Reference: For more information on this qualification standard, please visit…