The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope of the CPAC for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to promote improvements in patient care by maximizing the potential for the recovery of funds through systematic evaluation and analytical review of clinical information.

Duties

VA offers a comprehensive total rewards package: VA Nurse Total Rewards The RUR nurse is under the supervision of a Nurse Manager, Assistant Nurse Manager, or designee, who provides the administrative and clinical supervision and general instruction, plans and assigns work, assigns time schedules, approves leave, performs quality reviews, coordinates internal control audits, and completes performance evaluations. The RUR nurse is responsible for being self-directed in the delivery of revenue reimbursement processes and under moderate supervision and instruction by the registered nurse manager. Responsibilities of the RUR nurse include, but are not limited, to the following: *Applies the nursing process to conduct clinical reviews for the purpose of pre-certification, admission, continued stay, and discharge reviews to obtain approval from third party payers (TPP). *Safeguards patient privacy and maintains confidentiality of all electronic and printed patient information according to HIPAA guidelines, the Privacy Act, and VHA policy. *Conducts special eligibility reviews including Service Connection (SC), Agent Orange, Combat Vet, and other special authority (SA) eligibilities as per regulations for third party revenue encounters including Inpatient/Outpatient level of care, RXs, Care in the Community, DME, and Ambulance. *Takes corrective action for identified deficiencies compliant with CPAC quality review, quality assurance, and internal control audit processes. *Conducts clinical legal relatedness review for Regional Counsel TORT Claims, No Fault, and Worker's Compensation cases to validate related care for reimbursement.*Conducts clinical appeals as required by the third-party payers to overturn denials and increase reimbursement. *Responds to customer service issues regarding SC/SA care and treatment to validate billing appropriateness. *Completes unit specific documentation, based on CPAC RUR standards and policy. *Utilizes comprehensive knowledge of nursing clinical practice and case management principles to assess appropriate level of care and to ensure compliance with established non-VA care authorizations and guidelines. *Completes 4-6 month orientation to meet the complexity of working 40+ work drivers and documentation. *Successfully completes Blackboard training (training designed to introduce staff to revenue operations and the staff role). *Collaborates with internal and external customers in efforts of revenue recovery. *Tracks revenue charges and recovered to maintain and reach facility goals. *Reviews data analytics and metric expectations *Prioritize workload according to department need and leadership direction 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: Eight-hour shifts between the hours of 6:00am-5:00pm Monday- Friday Compressed/Flexible: Available Telework: Telework may be available as deemed appropriate. Virtual: This is not a virtual position. Functional Statement: RUR RN #92173A, 67528A, 38122A, 18551A, 11666A Bargaining Unit: 1276 Relocation/Recruitment Incentives: Not Authorized Financial Disclosure Report: Not required

Requirements

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Education. Graduate of a school of professional nursing. (1) Education Accreditation Requirement. Nursing education must be from a school of professional nursing accredited by one of the following accrediting organizations at the time the program was completed by the applicant: (a) The Accreditation Commission for Education in Nursing (ACEN), 3343 Peachtree Road NE, Suite 850, Atlanta, GA 30326. The ACEN accredits all levels of nursing programs, including clinical doctorate, masters/post master's certificate, baccalaureate, associate and diploma nursing education programs. (Note: The National League for Nursing Accrediting Commission/NLNAC changed its name to ACEN in May 2013. ACEN's website may be utilized to verify accredited programs using automated inquiry processes; however, for verification of any nursing program's accreditation prior to 1998, an automated inquiry cannot be used and ACEN must be contacted directly via their email contact information on the ACEN website to verify.); or (b) The Commission on Collegiate Nursing Education (CCNE), 655 K Street, NW, Suite 7, Washington, DC 20001. The CCNE is an accrediting arm of the American Association of Colleges of Nursing (AACN) and accredits nursing education programs at the bachelor and master's level. (2) Nursing Bridge Programs. Nursing bridge programs are accelerated nurse education programs which rely upon existing nursing knowledge and education. Graduates from nursing bridge programs that meet accreditation requirements specific grade level requirements in this standard must also be met in addition to the following: (a) Master's Level Bridge Program Education Appointments Prior to Graduation. Individuals attending a master's level bridge program in nursing who achieve the level in their education in which they 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 a temporary basis for any period up to three years contingent upon full completion of the professional nursing education program, if education verification provided by the school supports the Bachelor of Science in Nursing (BSN) equivalency. Upon successful completion and graduation from the bridge program, the Nurse may be converted to a permanent appointment under the provisions of section 7401(a)(1) of title 38. Failure to complete the bridge program on which the temporary appointment was based will result in termination of the appointment. (3) Additional Education Requirement for Nurse (Clinical Nurse Leader) Assignments. In addition to the basic requirements, a Nurse (Clinical Nurse Leader (CNL)) must possess a bachelor's level degree in nursing and a master's degree from an accredited CNL education program. (See certification requirement in 3c.(2) of this appendix). (4) Foreign Education. Graduates of foreign schools of professional nursing who possess a current, full, active and unrestricted registration (see paragraph 3c) will meet the requirement of graduation from an approved school of professional nursing to warrant appointment as a Nurse who has completed an associate degree level Nursing education program. In order to grant credit towards an appointment based on foreign nursing education higher than the associate degree level, formal degree equivalency validation from a recognized degree equivalency evaluation agency accepted by VA such as the International Consultants of Delaware (ICD) must be obtained. (5) Degree in a Related Field. A graduate level or doctorate degree in health care/management related fields from an institution accredited by the State and approved by the Department of Education at the time the candidate completed the program may be credited as specifically indicated in grade requirements. The graduate level or doctorate degree and coursework must provide evidence in support of the nursing role and duties associated with the assignment and grade level. Foreign education programs/degrees are not creditable as related degrees c. Licensure and Certification. The following licensure and certification requirements are considered conditions of employment. (1) Nurse. All Nurses must possess and maintain an active, current, full and unrestricted license as a Nurse to practice in a State, Territory or Commonwealth of the United States, or in the District of Columbia Preferred Experience: Strong clinical background with 3-4 years nursing experience, 1-3 years relevant case management or utilization review experience, InterQual/Millimen experience preferred. Knowledge and skilled in applying CPT, ICD 10, and HCPCS coding. Able to collaborate effectively and communicate with all areas within the revenue cycle. Familiar with insurance preauthorizations and retro authorizations. Detail oriented. Experience with improving processes. Familiar with data analytics. Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade: Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued sitting and computer use and typing. The RUR nurse must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on organizational needs and solve problems independently while utilizing critical thinking skills.

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address VA NCCPAC Madison 8001 Terrace Ave Middleton, WI 53562 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]