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Registered Nurse
2 months ago
General Duties include:
Assist in directing the provision of nursing education, orientation, competencies and providing quality improvement and enhance revenue outcome utilization.
Responsible for performing clinical review activities together with associated planning, developing, coordinating, and monitoring in the implementation of Veterans Affairs (VA) reimbursement program.
Collects, analyzes, and reports data.Collaborate 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.
Serve as patient advocate providing accurate and timely clinical information to third party payers.Ensure compliance with established third-party payer criteria for reimbursement and appeal of clinical denials.
Validate SC/SA relatedness for revenue cases.
Ensure all RUR staff provides feedback as appropriate, for performance improvement, utilization management, and compliance related issues.
Conduct precertification with third party payers including VA and Community Care as applicable.
Manage clinical denials for revenue.
Perform legal case relatedness review for revenue billing purposes.
Provide education to VA medical facility providers and other staff on revenue related topics.
Participate on CPAC and/or facility committees, workgroups, performance improvement projects, and/or huddle boards.
Collaborate 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.
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:
This position potentially requires flexibility in schedule and assignments.
Telework:
Available - Teleworks 6+ Days Per Pay Period
Virtual:
This is not a virtual position.
Relocation/Recruitment Incentives:
Not Authorized
Permanent Change of Station (PCS)
:
Not Authorized
Financial Disclosure Report:
Not required
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