Revenue Utilization Review (RUR) Assistant Nurse Manager

Revenue Utilization Review Assistant Nurse Manager

The Consolidated Patient Account Center (CPAC) is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, and the integration of VHA and industry best standards. The Revenue Utilization Review (RUR) Assistant Nurse Manager is accountable to the CPAC Director and RUR Nurse Manager, manages RUR Nurses and general schedule (GS) staff regionally within various states and the Commonwealth of the United States.

Responsibilities include:

• Managing RUR Nurses and general schedule (GS) staff.
• Possessing in-depth knowledge of service connection/special authority eligibility requirements, first- and third-party medical review criteria, nurse utilization review processes, clinical documentation requirements, current standards of care, and compliance guidelines.
• Executing leadership and oversight characterized by substantial and continuous responsibility and accountability for population groups and integrated programs that cross service lines.
• Being responsible for the administrative functions of the assigned service line staff.
• Establishing and maintaining effective relationships with all levels of Health Care System personnel and engaging effectively with customers, including VA Medical Center service lines within the assigned region, community providers, third-party payers (TPP), and program leaders at the local and national levels.

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: Monday - Friday, 8:00AM - 4:30PM.
• Telework: Not available.
• Relocation/Recruitment Incentives: Not Authorized.
• Permanent Change of Station (PCS): Not Authorized.

Requirements include:

• 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.
• 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.

Qualifications include:

• Basic Requirements:
• English Language Proficiency.
• Graduate of a school of professional nursing approved by the appropriate 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); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program.
• 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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program.
• 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.
• Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure.
• Grade Determinations:
• The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade.
• The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment.
• Nurse I, Level I: Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.
• Nurse I, Level II: Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.
• Nurse I, Level III: Demonstrates proficiency in practice based on conscious and deliberate planning.
• Nurse II: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.
• Nurse III: Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.
• Preferred Experience:
• Strong clinical background with 5 years nursing experience.
• 1-3 years relevant Utilization Review experience or previous CPAC experience.
• 1-3 years management experience.
• Ability to collaborate and communicate effectively.
• InterQual/Milliman experience.
• Case management or Utilization Review certification.
• Knowledge and skill in applying CPT, ICD 10 and HCPCS coding.

Physical Requirements: Physical demands of the work are generally minor, as the position requires sitting, standing, & walking. Work is primarily sedentary. May require prolonged standing, moderate walking, & manual dexterity. Requires carrying light items, such as books, files, or laptop computer. Must be in overall good health, able to sit at a desk working at a computer, engage in light to moderate physical activity including sitting, walking, bending, & carrying supplies. This position also requires close visual acuity to perform an activity such as viewing a computer terminal, transcribing, reading & repetitive motions of the wrists, hands, and or fingers.

This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. 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.