Revenue Utilization Review (RUR) Nurse Job in US Veterans Health Administration

US Veterans Health Administration, San Francisco, Openings : 1, Experience : Not Specified
Apply Here
Job Description :

Duties

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 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: 7:30am – 4:00pm Monday- Friday
Telework: Not available
Virtual: This is NOT a virtual position.
Functional Statement: Registered Nurse Clinical Reviewer FS #91273A, #11666A, #98183A, #38122A, #18551A
Bargaining Unit: 1276
Relocation/Recruitment Incentives: Not Authorized
Financial Disclosure Report: Not required

Requirements

Conditions of Employment

  • You must be a U.S. Citizen to apply for this job
  • All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
  • Selective Service Registration is required for males born after 12/31/1959
  • You may be required to serve a probationary period
  • Subject to a background/security investigation
  • Must be proficient in written and spoken English
  • Selected applicants will be required to complete an online onboarding process
  • Must pass pre-employment physical examination
  • Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)
  • Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Department of Veterans Affairs Personnel
  • Must complete VetPro Credentialing

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 12/23/2021.

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: Strong clinical background with 5 years nursing experience, 1-3 years relevant case management or utilization review experience required, Must be able to collaborate effectively and communicate with all areas within the revenue cycle. Previous experience in CPAC Revenue Utilization Review. InterQual experience. Case Management or Utilization Review certification preferred. Knowledge and skilled in applying CPT, ICD 10, and HCPCS coding.

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 bachelors degree in a related field with no additional nursing practice/experience; OR a Bachelors 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 Bachelors 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 Masters 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 Bachelors degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Masters 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 – Masters degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree in nursing or related field and approximately 2-3 years of nursing practice/experience.
The full performance level of this vacancy is VN III. The actual grade at which an applicant may be selected for this vacancy is in the range of VN I to VN III. The nursing board will determine the grade.

References: 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.

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.

Additional information

Testing Designated Position: All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.

Annual leave shall accrue for full-time Nurses, and Nurse Anesthetists at the rate of 8 hours for each full biweekly pay period.

This job opportunity announcement may be used to fill additional vacancies.

This position is in the Excepted Service and does not confer competitive status.

VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

  • Benefits

    A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

    Review our benefits

    Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, résumé, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.

NOTE: Candidates education, scope, and length of nursing practice (experience) will be considered by a Nurse Professional Standards Board in determining the grade and salary of the applicant selected. The recommended salary may be at any point in the range listed for this vacancy.

Experience as an RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following four dimensions of nursing: Practice, Professional Development, Collaboration and Scientific Inquiry. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.

  • Benefits

    A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

    Review our benefits

    Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • Required Documents

    As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether youre a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure youre eligible under their policies.

    To apply for this position, you must provide a complete Application Package which includes:

    • VA form 10-2850a – Application for Nurses and Nurse Anesthetists- Link to form provided in the “Required Documents” section of the announcement
    • LICENSE: A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet
    • Resume
    • Transcript


    VA Form 10-2850a – Application for Nurses and Nurse Anesthetists can be found at: https://www.va.gov/vaforms/medical/pdf/vha-10-2850a-091998-fill.pdf. The 10-2850a must be current and signed by applicant. (Required at time of application by all applicants)

    SF-50 – Current 2021 SF-50 required for all current federal employees.

    The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript, latest copy of SF-50s which includes your current grade/step/salary, copy of valid, current RN license verification, etc.

    A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet.

    • Cover Letter
    • DD-214/ Statement of Service
    • Disability Letter (VA)
    • VA form 10-2850a – Application for Nurses and Nurse Anesthetists- Link to form provided in the “Required Documents” section of the announcement
    • LICENSE: A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet
    • Performance Appraisal
    • Resume
    • SF-15
    • SF-50/ Notification of Personnel Action
    • Transcript


    Veterans Preference Note: Preference eligible candidates and other Veterans will be given preference when qualification of candidates are approximately equal for Title 38 positions in VHA. When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 “Application for 10 Point Veteran Preference” with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans Preference, please visit Feds Hire Vets – Veterans – Job Seekers – Veterans Preference.

    If you are relying on your education to meet qualification requirements:

    Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

    Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

  • How to Apply

    All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 12/23/2021 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/11329243.

    • To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
    • Click Submit My Answers to submit your application package.

    NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

    To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.

    As required by Executive Order 14043, Federal employees are required to be fully vaccinated against COVID-19 regardless of the employees duty location or work arrangement (e.g., telework, remote work, etc.), subject to such exceptions as required by law. If selected, you will be required to be vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. Per the Center for Disease Control and Prevention (CDC), you are fully vaccinated for COVID-19, 2 weeks after receiving the requisite number of doses of a COVID-19 vaccine approved or authorized for emergency use by the U.S. Food and Drug Administration or that has been listed for emergency use by the World Health Organization. For Pfizer-BioNTech, Moderna, or AstraZeneca/Oxford, full vaccination is 2 weeks after receiving the second dose in a 2-dose series. For Johnson and Johnson (J&J)/Janssen, full vaccination is 2 weeks after an employee has received a single dose.

    HR Office staff must verify your vaccination status prior to issuing a final offer of employment and before you report for New Employee Orientation. [In addition, new hires must show vaccination documentation and submit their completed VA FORM 10230, COVID-19 Vaccination Form, to VA HR staff when reporting for New Employee Orientation. HR staff will upload vaccination information in the VA Light Electronic Action Framework (LEAF) system. If you are unable to obtain the COVID-19 vaccination due to a legally covered exception (i.e., medical or religious reasons), VA will provide additional information regarding what information or documentation is needed and how you can request an exception. If you request a legally required exception, you must first complete the VA FORM 10230, COVID-19 Vaccination Form, and return the form to the servicing HR Office staff within 2 business days. The HR Office staff will submit the form to your new supervisor of record for adjudication of the exception request. You may receive a final offer or be appointed while your request for medical or religious exception is being adjudicated. Some positions must be adjudicated favorably prior to receiving a final offer. Please contact the HR Point of Contact listed in the JOA for more information.

    Agency contact information

    Lori Prebble

    Address
    VA WCPAC Las Vegas 736
    1085 Palm Airport DR
    Las Vegas, NV 89119
    US

    Next steps

    Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.

    You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.

    NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.

  • Fair and Transparent

    The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

    • Equal Employment Opportunity (EEO) Policy
    • Reasonable accommodation policy
    • Financial suitability
    • Selective Service
    • New employee probationary period
    • Signature and false statements
    • Privacy Act
    • Social security number request

Required Documents

To apply for this position, you must provide a complete Application Package which includes:

  • VA form 10-2850a – Application for Nurses and Nurse Anesthetists- Link to form provided in the “Required Documents” section of the announcement
  • LICENSE: A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet
  • Resume
  • Transcript


VA Form 10-2850a – Application for Nurses and Nurse Anesthetists can be found at: https://www.va.gov/vaforms/medical/pdf/vha-10-2850a-091998-fill.pdf. The 10-2850a must be current and signed by applicant. (Required at time of application by all applicants)

SF-50 – Current 2021 SF-50 required for all current federal employees.

The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript, latest copy of SF-50s which includes your current grade/step/salary, copy of valid, current RN license verification, etc.

A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet.

  • Cover Letter
  • DD-214/ Statement of Service
  • Disability Letter (VA)
  • VA form 10-2850a – Application for Nurses and Nurse Anesthetists- Link to form provided in the “Required Documents” section of the announcement
  • LICENSE: A current valid license or a printout of the State Boards online validation results indicating an unexpired and unrestricted license must be included with the application packet
  • Performance Appraisal
  • Resume
  • SF-15
  • SF-50/ Notification of Personnel Action
  • Transcript


Veterans Preference Note: Preference eligible candidates and other Veterans will be given preference when qualification of candidates are approximately equal for Title 38 positions in VHA. When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 “Application for 10 Point Veteran Preference” with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans Preference, please visit Feds Hire Vets – Veterans – Job Seekers – Veterans Preference.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.


Help

This job is open to

  • Federal employees – Excepted service

    Current excepted service federal employees.

  • Internal to an agency

    Current federal employees of this agency.

  • The public

    U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

1st Area of Consideration: Current station # 736 employees 2nd Area of Consideration: Current, permanent Department of Veterans Affairs employees

Last Date For Apply: 24/Mar/2022 10:03:00 Job Type : Full Time, Employment Type : Permanent Apply Here