Revenue Utilization Review Nurse

<p>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.</p><h3>Major Duties</h3><p>The Revenue Utilization Review (RUR) Registered 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: Serves as a patient advocate providing accurate and timely clinical information to third-party payers. Ensures compliance with established third-party payer criteria for reimbursement and appeal of clinical denials. Provides feedback as appropriate, for performance improvement, utilization management, and compliance related issues. Conducts precertification with third party-payers including VA and Community Care as applicable. Validates Service Connection (SC)/Special Authority (SA) relatedness for revenue cases. Manages clinical denials for revenue. Performs legal case relatedness review for revenue billing purposes. Provides education to VA medical facility providers and other staff on revenue related topics. Collaborates as needed for revenue cycle tasks with CPAC and VA medical facility staff, including but not limited to Facility Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and Community Care. Collects, analyzes, and reports data. Collaborates with third party payers on ordered level of care and treatment plans, conducting reviews on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review, concurrent review, denial management, retrospective review, admission, and continued stay patients. The RUR RN participates on CPAC and/or facility committees, workgroups, performance improvement projects, and/or huddle boards. Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level within a facility, Veterans Integrated Systems Network (VISN), or Veterans Affairs Central Office (VACO).. 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: 08:00am- 4:30pm Monday- Friday Compressed/Flexible: Compressed schedule maybe considered after training requirements have been met. Telework: No Virtual: This is not a virtual position. Must have ability to report to Leavenworth, KS. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): 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.