Revenue Utilization Review (RUR) Nurse
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 RN Clinical Reviewer include the following:
Uses the nursing process in obtaining third party precertification. Seeks direction from others in revenue processes. Completes orientation and RUR courses . Completes unit specific documentation, based on CPAC RUR standards and policy. Takes corrective action for identified deficiencies compliant with CPAC quality review, quality assurance, and internal control audit processes. Safeguards patient privacy and maintains confidentiality of all electronic and printed patient information according to HIPAA guidelines, the Privacy Act, and VHA policy. Reports privacy violations per CPAC 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 resulting in approvals and/or denials for non-VA care. Conducts clinical reviews to interpret and evaluate data directly related to diagnosis, condition, and treatment to assure appropriate medical necessity, appropriate care coordination, and timely utilization of services. Work Schedule:
typically 8:
00am- 4:
30pm M-F, per organizational needs Telework:
Possible for highly qualified applicants after full observation of performance and upon completion of training. Telework may be available up to 4 days a week. Virtual:
This is NOT a virtual position. Flex/Compressed:
Not available Functional Statement:
Registered Nurse Clinical Reviewer FS #91273A, #11666A, #67528A, #738122A, #18551A Full Performance Level:
Grade III. The actual grade at which an applicant may be selected for this vacancy is in the range of I to III Bargaining Unit:
1276 Financial Disclosure Report:
Not required This is NOT a Virtual or Remote position. To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/09/2019. 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. Graduate of a school of professional nursing approved by the appropriate State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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. 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. Preferred
Experience:
At least five (5) years clinical nursing experience as a RN, managed care experience as a RN or case management experience as a RN; proficiency in computer software programs (such as MS Word, Excel, Outlook, Explorer); strong writing; strong analytical ability, health assessment ability to obtain descriptions about patient symptoms, how the symptoms developed, and a process to discover any associated physical findings to identify level of care needed. 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 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's 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 year's of nursing practice/experience; OR a Doctoral degree in nursing or related field and approximately 2-3 year's 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.
Estimated Salary: $20 to $28 per hour based on qualifications.
Uses the nursing process in obtaining third party precertification. Seeks direction from others in revenue processes. Completes orientation and RUR courses . Completes unit specific documentation, based on CPAC RUR standards and policy. Takes corrective action for identified deficiencies compliant with CPAC quality review, quality assurance, and internal control audit processes. Safeguards patient privacy and maintains confidentiality of all electronic and printed patient information according to HIPAA guidelines, the Privacy Act, and VHA policy. Reports privacy violations per CPAC 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 resulting in approvals and/or denials for non-VA care. Conducts clinical reviews to interpret and evaluate data directly related to diagnosis, condition, and treatment to assure appropriate medical necessity, appropriate care coordination, and timely utilization of services. Work Schedule:
typically 8:
00am- 4:
30pm M-F, per organizational needs Telework:
Possible for highly qualified applicants after full observation of performance and upon completion of training. Telework may be available up to 4 days a week. Virtual:
This is NOT a virtual position. Flex/Compressed:
Not available Functional Statement:
Registered Nurse Clinical Reviewer FS #91273A, #11666A, #67528A, #738122A, #18551A Full Performance Level:
Grade III. The actual grade at which an applicant may be selected for this vacancy is in the range of I to III Bargaining Unit:
1276 Financial Disclosure Report:
Not required This is NOT a Virtual or Remote position. To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/09/2019. 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. Graduate of a school of professional nursing approved by the appropriate State-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). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (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. 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. Preferred
Experience:
At least five (5) years clinical nursing experience as a RN, managed care experience as a RN or case management experience as a RN; proficiency in computer software programs (such as MS Word, Excel, Outlook, Explorer); strong writing; strong analytical ability, health assessment ability to obtain descriptions about patient symptoms, how the symptoms developed, and a process to discover any associated physical findings to identify level of care needed. 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 year's of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 year's 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 year's of nursing practice/experience; OR a Doctoral degree in nursing or related field and approximately 2-3 year's 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.
- Department:
0610 Nurse - Salary Range:
$48,693 to $95,120 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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