Managed Care Chief Nurse
What you'd do
The Captain James A. Lovell Federal Health Care Center (FHCC) is seeking a candidate with excellent leadership, referral/consult management, coordination, and supervisory skills; a commitment to the highest standards of care; and a passion for advancing the health and well-being of those who have served.
Major duties
VISN 12 is committed to fostering and sustaining an environment which celebrates diversity, provides equitable opportunities for employment and promotion, and supports inclusiveness in our culture. Together, we strive to create and maintain working and learning environments that promote professional growth and teamwork, and are inclusive, equitable and welcoming. We embrace our differences as individuals and unite as a team toward a common goal: to serve our nation's Veterans. The Nurse IV Chief Nurse functions as an advisor, administrator, educator, consultant, and mentor who possesses a wide range of experience and leadership ability and is responsible for administrative functions of their assigned units/programs. Major duties and responsibilities of the position: The Nurse IV Chief Nurse provides senior leadership and oversight for daily clinical and administrative operations within the Managed Care Department. The Nurse IV Chief Nurse coordinates and collaborates with the providers responsible for reviewing and approving Functional Statement: Nurse IV Page 2 referral requests, and providers who oversee the review, approval, or denial of unauthorized non-VA care claims in accordance with established eligibility criteria. The Nurse IV Chief Nurse functions in an advisory capacity to administration in evaluating proposed changes as it relate to patient care. The Nurse IV Chief Nurse provides executive leadership and oversight to the Nurse Managers of Referral Management and Office of Community Care (OCC). Oversight is also provide to the clinical and administrative staff, Referral Coordination Team (centralized referral coordination teams), Interfacility Consult Coordinators, and the Referral Management Coordinators (DoD Tricare network referrals). The Nurse IV Chief Nurse works effectively with other Associate Chief Nurses and Nurse Managers to ensure clinical oversight for nursing as well as providing essential support for planning and implementing appropriate resource utilization and distribution. The Nurse IV Chief Nurse collaborates with interdisciplinary team members, including other program and service leaders at the facility and network. They work closely to establish and maintain effective relationships with all levels of Veteran Affairs (VA) staff nationwide. 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: Monday-Friday, 7:30 a.m. - 4:00 p.m. Telework: Not Authorized. Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized. Permanent Change of Station (PCS): Not Authorized.
What you need to qualify
Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. The following Scope, Education and Dimension criteria must be met to qualify for Nurse IV: Scope: Executes leadership that is characterized by substantial and continuous responsibility and accountability for population groups or integrated programs that cross service and/or discipline lines and influence organizational mission and health care. Education: Master's degree in Nursing (MSN) and 4 years of professional nursing experience, one of which is specialized nursing experience equivalent to Nurse III and meets all dimension requirements for Nurse IV; OR Master's degree in a *related field with a BSN and 4 years of professional nursing experience, one of which is specialized nursing experience equivalent to Nurse III and meets all dimension requirements for Nurse IV; OR a Doctoral degree in nursing and 3 years of professional nursing experience, one of which is specialized nursing experience equivalent to Nurse III and meets all dimension requirements for Nurse IV; OR a Doctoral degree in a *related field with a BSN and 3 years of professional nursing experience, one of which is specialized nursing experience equivalent to Nurse III and meets all dimension requirements for Nurse IV. *Note: Foreign education programs/degrees are not creditable as related degrees. Dimensions: Leadership. Leads health care delivery by leveraging evidence-based practices, industry-leading research, and innovative care models. Drives a shared vision and successfully leads change to improve performance and attain measurable outcomes at the program or service level. Business Acumen. Transforms health care by implementing new processes, technology, informatics, and data analytics using business models and fundamental concepts of resource management at the program or service level. Inspiring an Industry-Leading Lifestyle. Employs an industry leading, shared decision-making lifestyle. Cultivates a workforce that serves Veterans, families and caregivers of all backgrounds and builds trust, lifestyle competencies and catalyzes dynamic teams at the program or service level. Communication and Relationship Management. Directs the effective use of relationship management principles to achieve positive customer service experiences that are consistent with professional organizational values, beliefs and practices at the program or services level. Professional and Social Responsibility. Operationalizes a lifestyle of holistic care, health advocacy and health equity. Applies ethical principles in decision-making at the program or service level. Advances nursing knowledge through health science research and the translation and dissemination of evidence into practice to maximize the value to Veterans and the community. Preferred Experience: Have at least a Master Degree in a related health-care field; a Master of Science in Nursing via a Bridge Program (no BSN required); or a Doctoral Degree in Nursing or related health-care field with a BSN and Master Degree in Nursing or a related health-care field. Have a minimum of three (3) years experience in progressively responsible leadership assignments, with demonstrated supervisory/administrative competencies in directing change and effectively managing human resources. This may be demonstrated through experience as a Nurse Manager/Supervisor, Clinical Nurse Leader, or Assistant/Associate Chief Nurse (or equivalent) at a larger, more complex healthcare facility. Excellent interpersonal skills and the ability to work independently as well as collaboratively with multiple service lines and disciplines. Proven ability to facilitate group problem solving, along with previous experience leading and/or facilitating performance improvement projects, teams, and groups. Demonstrated ability in data tracking, management, analysis, and feedback of results. Demonstrated leadership and supervisory experience managing both nursing and administrative staff, fostering a collaborative and high-performing team environment. Extensive experience in referral/consult management in the Office of Community Care, including TRICARE. Expertise in Office of Community Care and TRICARE referrals/consults, including eligibility review and determination processes. Proven track record in care coordination and claims processing, ensuring timely access to high-quality care across VA, DoD, and community providers. Strong working knowledge of Office of Community Care programs and related referral/consult processes, including oversight of consults, authorizations, and vendor relationships. Implementing and ensuring compliance with VHA Directives and Operating Models related to the Office of Community Care. Demonstrated ability to communicate and present effectively before senior executive leadership, providing high-level briefings and advocating for programmatic needs and improvements. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Physical Requirements: This position includes a level of physicality normally associated with duties performed by nurses such as potentially long periods of walking, climbing stairs, standing, sitting, repeated bending, or kneeling. Examples may include: - Significant amount of time sitting and typing processing of referrals. - Significant amount of time speaking with internal and external customers on the phone.
Before you apply
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