The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for a region while monitoring the quality of care through critically examining patient medical records, paying close attention to the appropriateness of healthcare expenditures. The RUR ANM relies on experience, education, and awareness of appropriate evidence-based review criteria to compile an accurate account of patient clinical pictures. The RUR ANM is responsible to provide leadership and supervision to the RUR staff nurses and Program Support Assistants (PSAs) who review (PSAs use algorithm) service connection (SC) and special authority (SA) eligibility before relaying any information to external reviewers representing third-party payers (TPPs). The RUR ANM possesses clinical and nurse leadership skills and demonstrates this through communication, mentoring and grade-appropriate critical thinking. Responsibilities of the RN ANM include the following: * The RUR ANM guides designated subordinates to collaborate among professional team members involved in each patient's care to draw team members' input and form the most comprehensive clinical picture, which the staff nurse then relays to insurance reviewers. * The RUR ANM's primary commitment is to the patient, whether an individual, family, group, or community (ANA Code of Ethics for Nurses). * Leads and organizes the RUR nursing program to ensure continuity of operations, peer accountability and consistency in nursing practice and RUR program contributions to improvements in access to and quality of care. * Functions as a competent consultant in clinical practice and revenue utilization review. * Systematically evaluating current practice, and formulating outcomes for groups of nurses, patients and/or organizational processes within revenue utilization review nursing, * Participates in establishing goals, solving problems and collaborating with other departments both in the facility and in the CPAC to enhance the clinical RUR nursing program. * Reads and correctly interprets CPAC RUR policies and procedures and guidelines and ensures staff compliance. Work Schedule: 8:00am- 4:30pm Monday- Friday Telework: ADHOC only Virtual: This is NOT a Virtual or Remote position. Functional Statement: RUR Assistant Nurse Manager FS #69284A, #49321A, and #93640A Full Performance Level: Grade III. The actual grade at which an applicant may be selected for this vacancy is in the range of I to III
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.