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Nurse - Revenue Review Utilization
2 months ago
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.
Ensures all RUR staff 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:
Mondays - Friday; 7:00am-3:30pm.
Telework:
Available.
Virtual:
This is not a virtual position.
Relocation/Recruitment Incentives:
Not Authorized.
Permanent Change of Station (PCS)
: Not Authorized.
