Registered Nurse (Utilization Review)
Department Of Veterans Affairs - Oklahoma City, OK

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Vacancy Identification Number OY831474MSG

THIS APPOINTMENT IS NOT TO EXCEED (NTE) 3 YEARS IN THE EXCEPTED SERVICE UNDER TITLE 38, HOWEVER, IT CAN BE EXTENDED BASED ON THE NEEDS OF THE AGENCY.

Area of Consideration: 1 st : All Employees assigned to Station 731; 2 nd : VA Wide Employees; 3 rd : Other Status Eligibles; 4 th Public

Our mission: To fulfill President Lincoln's promise - "To care for him who shall have borne the battle, and for his widow, and his orphan" - by serving and honoring the men and women who are America's Veterans.

YOU CAN MAKE A DIFFERENCE

We are pleased to announce a dynamic and exciting opportunity available for an experienced Registered Nurse (Utilization Review) for the Consolidated Patient Accounts Center (CPAC) located in Smyrna, TN. TOTAL OF SIX (6) VACANCIES . DUTY LOCATION AVAILABLE AT ANY VA FACILITY LISTED. SALARY DEPENDENT UPON DUTY LOCATION SELECTED. LISTED SALARY IS SPECIFIC TO THE MSCPAC REGIONAL OFFICE IN SMYRNA, TN. 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.

Relocation expenses are not authorized.

The Mid-South Consolidated Patient Accounts Center is not authorized to fund initiatives within the Employee Incentive Scholarship Program (EDRP, NNEI, ect). All queries regarding such programs should be addressed to the VA Healthcare Retention Office. KEY REQUIREMENTS

You must be a US citizen to apply for this job
Selectees are subject to fingerprint and background investigation.
Selectees may be subject to a two-year probationary/trial period.
More than one selection may be made from this announcement.
All requirements must be met by the closing date of this announcement.

Designated and/or random drug testing required. DUTIES:
Responsibilities of the RUR (Registered Utilization Review) Nurse include:

  • Pre-certification, admission, concurrent discharge, retrospective and appeals/denial reviews to obtain approval from third party payers for services provided to Veterans.
  • Uses advanced clinical knowledge and communication skills to efficiently and effectively perform the clinical review in CPRS and to contact the third party payer for authorization of services.
  • The RUR nurse is a patient advocate and program liaison and 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 conducts special eligibility validation reviews including SC, Agent Orange, Combat Vet, etc.
  • The RUR nurse 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.
  • Actively participates in program development at the facility level and works to identify clinics that need to be added to the Stockamp High Dollar Clinic List.
  • Conducts SC reviews using Quadramed and also assists with clinical reviews as directed by the CBO: i.e., The Combat Vet Project.
  • The RUR nurse at the facility level performs reviews for their facility as well as provides support to other facilities within the CPAC.
PREFFERRED: At least five (5) years of Utilzation Review/Case Management experience.

Guaranteed Home Buyout is not authorized.

TOUR OF DUTY: A Part-Time schedule agreed upon by management and selectee

Relocation Expenses: Relocation expenses are not authorized for this position. QUALIFICATIONS REQUIRED:

  • Citizen of the United States.
  • 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 National League for Nursing Accrediting Commission (NLNAC) or The Commission on Collegiate Nursing Education (CCNE).
  • 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 . 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.
  • Must be proficient in spoken and written English .
PREFERRED QUALIFICATION: At least five (5) years of nursing experience in utilization review and/or case management is preferred .

CONDITIONS OF EMPLOYMENT : (Failure to comply may be grounds for withdrawal of an offer of employment or dismissal after appointment)

Applicants must be citizens of the United States. Required English Language Proficiency

Applicants tentatively selected for certain designated positions may be subject to a random drug screening for illegal drug use. Applicants who refuse to be tested will be denied employment.

Applicants must not be listed on the Department of Health and Human Services (DHHS) Office of Inspector General Sanctions database.

New Appointees will be subject to a background investigation to determine suitability. Male applicants born after December 31, 1959, must certify at the time of appointment that they have registered with the Selective Service system or are exempt for having to do so under Selective Service law.

VETPRO : Selected candidate will be required to successfully complete a credential process before entering on duty. This process includes employment verification, personal history, education & license/registration/certification verification, and reference check. Selected candidate will be required to provide a certified copy of college transcript(s) and information on any licenses/certifications/or registrations currently or previously held

Education/Experience Requirements :
  • Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, no experience.
  • Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of experience, or an ADN or Diploma in Nursing and a bachelor's degree in a related field and no experience; or a Bachelors of Science in Nursing (BSN) and no experience.
  • Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of experience, or an ADN or Diploma in Nursing and a bachelors degree in a related field and approximately 1-2 years of experience; or a BSN with approximately 1-2 years of experience, or a Master's degree in nursing (MSN) or related field with a BSN and no experience.
  • Nurse II - A BSN with approximately 2-3 years of experience, or ADN or Diploma in Nursing and a bachelors degree in a related field and approximately 2-3 years experience or a Master's degree in nursing or related field with a BSN and approximately 1-2 years experience, or a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no experience.
  • Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years experience or Doctoral degree in nursing or related field and approximately 2-3 years experience.
Applicant's education and length of nursing practice (experience) will be considered by a Nurse Professional Standards Board in determining the grade and salary of the applicant selected. Experience as a RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following four dimensions of nursing: Practice, Professional Development, Collaboration and Scientific Inquiry. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel. The criteria are as follows: Practice: practice, ethics and resource utilization, Professional Development: performance, education/career development, Collaboration; collaboration, collegiality, Scientific Inquiry: quality of care, research.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE .

Reference: VA Handbook 5005/27, Part II, Appendix G-6 NURSE QUALIFICATION STANDARD

APPLICANTS PLEASE NOTE: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement.) Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html All education claimed by applicants will be verified by the appointing agency accordingly. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education

Special Employment Consideration: Individuals eligible for the following appointments are encouraged to apply: 5 CFR 213.3102 "u", Schedule A, Appointment of persons with disabilities, intellectual disabilities, severe physical disabilities, or psychiatric disabilities; and Disabled veterans with a compensable service-connected disability of 30% or more.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP ): Provides eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 90 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/ctap/index.asp .

Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer a newly-appointed Federal employee credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave.

Veterans’ Preference: When applying for federal jobs eligible veterans should claim preference on their application or resume. Applicants claiming 10-pt preference must complete an SF-15 “Application for 10 pt Veterans Preference.” Veterans who are still in the service may be granted a tentative 5 pt preference on the basis of information claimed in their application. Applicant must produce a DD 214 or other proof prior to appointment to document entitlement to preference. To learn more about Veterans’ Preference please visit http://www.fedshirevets.gov/job/veterans.aspx . HOW YOU WILL BE EVALUATED:

Once the application process is complete, a review of your application will be made to ensure you meet the job requirements. Incomplete Applications will be disqualified and will receive no further consideration. Requests for reconsideration will not be considered for applicants who fail to submit a complete application package. We cannot be held responsible for delays in mail service, etc.

BENEFITS:
Working for the Department of Veterans Affairs offers a comprehensive benefits package that includes, in part, paid vacation, sick leave, holidays, life insurance, health benefits, and participation in the Federal Employees Retirement System. In addition to traditional "dollars and cents" benefits, we offer a range of benefits to help balance work and life. For more information please visit us at http://www4.va.gov/JOBS/Job_Benefits/benefits.asp .

OTHER INFORMATION:
  • The materials you send with your application will not be returned to you.
  • We cannot be held responsible for incompatible software, fax transmissions, delays in mail service
  • Applications received in government pre-paid envelopes will not be considered.
  • This job opportunity announcement may be used to fill additional vacancies.
  • This position is in the Excepted Service and does not confer competitive status

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The United States Department of Veterans Affairs (VA) is a government-run military veteran benefit system with Cabinet-level status. It is...