Revenue Utilization Review (RUR) Nurse
Job Location:
Smyrna, GA - USA
Yearly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
The Consolidated Patient Accounts 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) Registered Nurse (RN) is an active member of the revenue cycle program and functions within the scope of the CPAC.
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: Monday- Friday 8:00am- 4:30pm (Schedule may vary based on facility need)
Compressed/Flexible: Not Authorized
Telework: Not Available
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
- 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 drivers 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.
Basic Requirements:
- English Language Proficiency. In accordance with 38 U.S.C. 7403(f) no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
- 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 masters level bridge program in nursing who have completed coursework equivalent to a bachelors 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. Upon achievement of a State license the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (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 to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).
- 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 (may be extended up to two years on a case-by-case-basis.)
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: I Level I
Reference: For more information on this qualification standard please visit Experience:
- Strong clinical background with 5 years nursing experience.
- 1-3 years of relevant case management or utilization review experience.
- Ability to collaborate effectively and communicate with all areas within the revenue cycle.
- Previous experience in CPAC Revenue Utilization Review.
- InterQual/Milliman experience.
- Utilization Review certification.
- Proficiency in applying CPT ICD-10 and HCPCS coding.
- Proficiency in Microsoft Word Microsoft Excel and related computer applications as well as the ability to accurately enter and manage information within designated online portals.
- Proficient in learning through diverse educational modalities including virtual formats.
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. See VA Directive and Handbook 5019.
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.
If you are unable to apply online or need an alternate method to submit documents please reach out to the Agency Contact listed in this Job Opportunity Announcement.
Under the Fair Chance to Compete Act the Department of Veterans Affairs prohibits requesting an applicants criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process visit Human Resources and Administration/Operations Security and Preparedness (HRA/OSP) at The Fair Chance Act.
Candidates should be committed to improving the efficiency of the Federal government passionate about the ideals of our American republic and committed to upholding the rule of law and the United States Constitution.
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
Required Experience:
IC
