Revenue Utilization Review - Overview LocationsHines, IL; Indianapolis,
IN; Columbus, OH; Middleton, WI; Tomah, WI Summary CPAC is a regionally
consolidated business entity established to enhance resource operations
throughout the VHA network by standardization and consolidation of
functions, and the integration of VHA and industry best practices. The
CPAC team provides revenue services for multiple medical centers,
located within its assigned geographical area. CPAC is not part of the
VA Medical Center The Revenue Utilization Review (RUR) nurse is an
active member of the revenue cycle program and functions within the
scope of the Consolidated Patient Accounting Center (CPAC) for revenue
reimbursement. The RUR Nurse possesses advanced clinical knowledge and
communication skills and promotes improvements in patient care by
maximizing the potential for the recovery of funds through systematic
evaluation and analytical review of clinical information. Duties *
Pre-certification, admission, concurrent discharge, retrospective and
appeals/denial reviews to obtain approval from third party payers (TPP)
for services provided to Veterans * Uses advanced clinical knowledge and
communication skills to efficiently and effectively perform the clinical
reviews and contact the TPP for authorization of services provided to
veterans * Acts as a patient advocate and program liaison that conducts
focused reviews requiring clinical input for sensitive diagnosis,
special consent issues, service-connected and special eligibility
validation, as well as clinical reviews for tort feasor and workers
compensation cases * Reviews and conducting special eligibility
validation reviews including Service Connection (SC) , Agent Orange,
Combat Vet, etc. * Collaborates with clinical staff to provide
education, feedback, and assistance regarding documentation of medical
necessity, insurance review criteria, and SC issues and documents the
results of the review in VISTA and Stockamp and coordinates continuity
of care with facility revenue staff as needed * Collaborates with the
facility revenue staff for ROI documentation, and logs disclosure of ROI
in the ROI package, or provides the necessary information to the ROI
staff at the facility * Participates in program development at the
facility level and works to identify clinics that need to be added to
the Huron High Dollar Clinic List * Conducts service connection reviews
using Quadramed and also assists with clinical reviews as directed by
the CBO: i.e., The Combat Vet Project * Performs reviews for their
facility as well as provides support to other facilities within the CPAC
- Conducts clinical appeals either oral or written ad required by TPPs
to overturn denials and increase reimbursement * Responds to customer
service issues regarding SC and other Special Authority (SA) eligibility
care/treatment to validate billing appropriateness or need for billing
exemption and/or Veteran refund. Telework: May be available for a highly
qualified applicants after full training and six months observation of
performance. Flex/Compressed: Same conditions for telework above. Tour
of Duty: 8:00 AM to 4:30 PM, Monday to Friday Functional Statement:
Registered Nurse Revenue - Utilization Review (RUR) #000000 Bargaining
Unit: 1276 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 Financial Disclosure Report: Not required - $51,410 $115,607 Job
Details Application Open Date 3/9/2018 Application Close Date 3/19/2018
Organization Veterans Affairs, Veterans Health Administration Who May
Apply None Status None - Annual leave shall accrue for full-time Nurses,
and Nurse Anesthetists at the rate of 8 hours for each full biweekly pay
period. Selected applicants will be required to complete an online
onboarding process. This job opportunity announcement may be used to
fill additional vacancies. It is the policy of the VA to not deny
employment to those that have faced financial hardships or periods of
unemployment. This position is in the Excepted Service and does not
confer competitive status. United States Citizenship Required;
non-citizens may only be appointed when it is not possible to recruit
qualified citizens in accordance with VA Policy. 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. Veterans and Transitioning Service Members:
Please visit the - 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. If
you are unable to apply online view the following link for information
regarding an - . - Qualifications - 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. 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. 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. -
Benefits - 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 03/19/2018 to receive consideration. - 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.