Assistant Nurse Manager - Revenue Utilization Review

<p>The Revenue Utilization Review (RUR) Assistant Nurse Manager role is a highly specialized leadership position that requires extensive knowledge of revenue cycle operations, utilization review processes, payer authorization requirements, denial prevention strategies, regulatory compliance, and organizational financial goals.</p><h3>Major Duties</h3><p>Perform utilization review activities, including medical necessity reviews, insurance authorizations, prior authorizations, appeals, and denial management, ensuring compliance with payer requirements. Analyze clinical documentation to identify reimbursement opportunities and support revenue integrity initiatives. Apply strong critical thinking and clinical judgment to evaluate complex cases and make informed recommendations regarding medical necessity and authorization requirements. Triage workload effectively, manage competing priorities, and meet deadlines in a fast-paced office environment while maintaining accuracy and productivity. Lead, mentor, and support nursing and utilization review staff to promote collaboration, performance improvement, and operational efficiency. Communicate and collaborate effectively with providers, payers, revenue cycle teams, and interdisciplinary stakeholders, demonstrating strong organizational and interpersonal skills. 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: 8:00AM-4:30PM Compressed/Flexible: Not Eligible Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized</p><h3>Requirements</h3>U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. 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. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. 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). You may be required to serve a probationary period. Complete all application requirements detailed in the "Required Documents" section of this announcement.