Nurse

<p>This position serves as a Nurse functioning in the role of a Clinical Nurse Reviewer (CNR) within the Program Management Office (PMO), Veteran and Family Member Programs (VFMP) Directorate, Integrated External Networks (IEN), Integrated Veteran Care (IVC), Veterans Health Administration (VHA). The VFMP Directorate is responsible for developing, implementing, and managing a comprehensive quality assurance program focused on identifying, assessing, and mitigating program vulnerabilities.</p><h3>Major Duties</h3><p>Major Duties: Conducts clinical reviews to determine medical necessity, service connection validation, and preauthorization requirements following VFMP and VHA policies. Evaluates utilization of health care benefits and assesses quality, efficiency, and appropriateness of care across VFMP programs. Accurately documents clinical review findings and ensures compliance with quality assurance, internal controls, and audit standards. Collaborates with interdisciplinary teams to clarify medical necessity, support coordinated care, and enhance claims adjudication accuracy. Responds to internal and external clinical inquiries promptly, providing clear guidance on eligibility, benefit criteria, and documentation needs. Applies evidence-based practice, medical research, and standardized review tools (e.g., SEOCs, InterQual) to clinical decision-making. Participates in quality improvement initiatives at the program or service level, contributing to development and refinement of review criteria, processes, and guidelines. Maintains compliance with privacy, information security, and ethical standards while handling sensitive medical and beneficiary data. 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: Full-time, 8-hour shifts Monday through Friday, with tours scheduled between 6:00am-6:00pm MST. Compressed/Flexible: Available Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized This is a bargaining unit position.</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.