Revenue Utilization Review Nurse

$71,612 - $125,559/Yr

United States Department of Veterans Affairs - Lebanon, PA

Part-time,Full-time - Entry Level

Onsite - Lebanon, PA

Administration of Human Resource Programs

About the position

The Revenue Utilization Review (RUR) Nurse at the Department of Veterans Affairs is responsible for overseeing the revenue cycle program, ensuring compliance with reimbursement criteria, and advocating for patients by providing accurate clinical information to third-party payers. This role requires advanced clinical knowledge and collaboration with various departments to improve patient care and maximize revenue recovery. The RUR Nurse operates under moderate supervision and is involved in performance improvement initiatives and compliance-related issues.

Responsibilities

• Serve as a 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.
• Provide feedback for performance improvement, utilization management, and compliance-related issues.
• Conduct precertification with third-party payers including VA and Community Care as applicable.
• Validate Service Connection (SC)/Special Authority (SA) relatedness for revenue cases.
• 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.
• Collaborate with CPAC and VA medical facility staff on revenue cycle tasks.
• Collect, analyze, and report data related to revenue cycle management.
• Participate on CPAC and/or facility committees, workgroups, and performance improvement projects.

Requirements

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens.
• Graduation from a school of professional nursing approved by the appropriate accrediting agency.
• Current, full, active, and unrestricted registration as a graduate professional nurse in a state, territory, or commonwealth of the U.S.
• Proficiency in English language, both written and spoken.

Nice-to-haves

• Strong clinical background with at least five years of nursing experience.
• 1-3 years of relevant case management or utilization review experience preferred.
• Experience in CPAC Revenue Utilization is useful.
• InterQual experience is preferred.
• Case Management or Utilization Review Certification preferred.
• Knowledgeable in applying CPT, ICD 10, and HCPCS coding.
• Strong written communication skills for documentation and communication with providers and payers.

Benefits

• Competitive salary with regular salary increases and potential for performance awards.
• 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays).
• Traditional federal pension and federal 401K with up to 5% contributions by VA.
• Federal health, vision, dental, term life, and long-term care insurance options.