Veterans Affairs, Veterans Health Administration Registered Nurse (Utilization Review) in Lebanon, Pennsylvania

Job Overview

Job Overview
Summary

Vacancy Identification Number (VIN): 1998739

Area of consideration: 1st AOC: Station 734 employees 2nd AOC: VA Employees 3rd AOC: Status Candidates 4th AOC: US Citizens

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."

We are pleased to announce a dynamic and exciting opportunity available for an experienced Registered Nurse (Revenue Utilization Review) for the Veterans Health Administration, Chief Business Office, Consolidated Patient Accounts Center located in Lebanon, PA.

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.

NOTE: Applicant's education and length of nursing practice (experience) will be considered by a Nurse Professional Standards Board in determining the grade and step of the applicant selected.

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.

*The health related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.

Duties

VHA's Consolidated Patient Account Center (CPAC) strives to improve efficiency and accountability in revenue operations. There are seven regionalized CPAC centers that conduct medical billing functions for VA Medical Centers (VAMCs) around the country. The CPAC program works with VAMCs to generate this revenue from insurance companies. To ensure that VA has the ability to bill insurers, VAMC staff ask Veterans to update their health insurance information at each visit. Current insurance information is needed for all Veterans with private health insurance or with federally funded coverage through the Department of Defense (TRICARE) or Medicare. By providing this information, Veterans can use their insurance benefits to help offset co-co-pays that VA may charge for non-service connected care. Providing health insurance information also benefits all Veterans by generating more funds for VAMCs to provide healthcare services.

Responsibilities of the Revenue Utilization Review Registered Nurse include the following: * 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 * Acts as a patient advocate and program liaison that 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 conducting special eligibility validation reviews including SC, Agent Orange, Combat Vet, etc. * 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 * Participates in program development at the facility level and works to identify clinics that need to be added to the Huron High Dollar Clinic List * Conducts service connection reviews using Quadramed and also assists with clinical reviews as directed by the CBO: i.e., The Combat Vet Project * Performs reviews for their facility as well as provides support to other facilities within the CPAC Telework and Flex/Compressed Schedule: Not Authorized. Incumbent will report to the Northeast CPAC location in Lebanon, PA. Tour of Duty: 8 AM to 4:30 PM. Functional Statement: #00000 Physical Standards: The work is mostly sedentary and is performed in an office setting. The work environment involves everyday risks or discomforts, which require normal safety precautions typical of such places as offices, meeting and training rooms, or libraries. The work area is adequately lighted, heated, and ventilated. Other physical demands include reaching, bending, stretching, walking, and carrying light loads of supplies. Bargaining Unit: 1276 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.

Supervisory Status

No

Promotion Potential

00

Travel Required
  • Not Required
Relocation Authorized
  • No
Who May Apply
This job is open to…

US Citizens and Status Candidates

Questions? This job is open to 2 groups.

Job Requirements

Job Requirements
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.
  • Selective Service Registration is required for males born after 12/31/1959
Qualifications

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

*Preferred Experience: *

The ideal candidate will possess at least one (1) year of experience as a Registered Nurse Clinical Reviewer; at least five (5) years clinical nursing experience as a RN or managed care experience as a RN or case management experience as a RN; proficiency in computer software programs (such as MS Word, Excel, Outlook, Explorer); strong writing skills to write in a clear, concise, organized, and convincing manner for intended audiences; strong analytical abilities to examine, understand, interpret and synthesize material present in English, using verbal and written formats; and strong health assessment abilities to obtain descriptions about patient symptoms, how the symptoms developed, and a process to discover any associated physical findings to identify level of care needed. When describing your experience, please be clear and specific.

* *Required Experience:

  • Current or previous clinical experience.

  • Documented skill in effective interpersonal relations and collaboration with interdisciplinary team members.

  • Documented skill in effective communication skills and professional behaviors that promote cooperation and teamwork with internal and external customers.

  • Documented skill in independent decision-making, sound clinical judgment and critical thinking abilities.

  • Documented knowledge of quality improvement issues related to the utilization of resources.

  • Documented evidence of dependability and reliability.

Nurse I, Level 1 Qualifications

Associate Degree or Diploma in Nursing

Nurse I, Level 2 QualificationsSpecialized experience: 1 year of specialized experience in nursing with a Associate Degree or Diploma in Nursing

Or

Associate Degree or Diploma in Nursing and Bachelors' degree in a related field

Or

Bachelor of Science in Nursing

Nurse I, Level 3 QualificationsSpecialized experience: 2-3 years of specialized experience in nursing with a Associate Degree or Diploma in Nursing

Or

Specialized experience: 1-2 years of specialized experience in nursing with a Associate Degree or Diploma in Nursing and Bachelors' degree in a related field.

Or

Specialized experience: 1-2 years of specialized experience in nursing with a Bachelors' degree in Nursing

Or

Master's degree in nursing or related field with BSN

Nurse II Qualifications

Specialized experience: 2-3 years of specialized experience in nursing with a BSN or Associate Degree or Diploma in Nursing and Bachelors' degree in a related field.

Or

Specialized experience: 1-2 years of specialized experience in nursing with Master's degree in nursing or related field with BSN.

Or

Education: Doctoral degree in nursing or meets basic requirements for appointment and has a doctoral degree in a related field.

Nurse III Qualifications

Specialized experience: 2-3 years of specialized experience in nursing with a Master's degree in nursing or related field with BSN.

Or

Education: Doctoral degree in nursing or related field.

Reference: Veterans Health Administration, Veterans Affairs Handbook 5005, Appendix G6, Nurse Qualification.

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.

  • 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.

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

  • VET PRO: 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.

Your degree 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 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.

Graduates of a school of professional nursing approved by the appropriate State 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), an accrediting arm of the National League for Nursing located at 61 Broadway, 33rd Floor, New York, New York 10006 or call (800) 669-1656 extension 153. The NLNAC accredits all levels of nursing programs. Additional information may be obtained from the NLNAC web site (www.acenuring.org); or, The Commission on Collegiate Nursing Education (CCNE), an accrediting arm of the American Association of Colleges of Nursing (AACN). The CCNE accredits bachelors and masters degree programs, and is located at One Dupont Circle N.W., Suite 530, Washington, DC 20036 or call (202) 463-6930. Additional information may be obtained from the CCNE web site (http://www.aacn.nche.edu/ccne-accreditation/accredited-programs).

NOTE: If your school and degree level is not listed at either website you may request historical accreditation information directly through the ACEN website: http://www.acenursing.org

Basic Requirements: * Must be a citizen of the United States* Must be a graduate from School of Nursing: Graduate of a school of professional nursing approved by the appropriate State agency, and accredited by The National League for Nursing Accrediting Commission (NLNAC), an accrediting arm of the American Association of Colleges of Nursing --OR-- The Commission on Collegiate Nursing Education (CCNE), an accrediting arm of the American Association of Colleges of Nursing (AACN). [NOTE: See exception below for candidates who are enrolled in a MSN Bridge Program.]MSN Bridge Program: The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. In these programs, students are given a certificate of professional nursing to sit for the NCLEX and should submit this certification to VA prior to appointment. Students do not earn a BSN, but receive a MSN degree upon completion of course work. A copy of the MSN transcript must be provided to VA. Bridge programs that confer a master's degree also fully meet the education requirement, even though a Bachelor's Degree is not awarded.Foreign nursing education: 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. You MUST submit a copy of your CGFNS or NCLEX-RN passing exam results. * Must possess a full and current nursing license registration: A registered nurse (RN) will have a current, full, active and unrestricted registration as a graduate professional nurse in a State, Territory, or Commonwealth (i.e., Puerto Rico) of the U.S. or in the District of Columbia. The RN must maintain a current, full, active and unrestricted registration to continue employment with VA.

Security Clearance

Public Trust - Background Investigation

Additional Information

Additional Information
What To Expect Next

After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. You may check the status of your application at any time by logging into your USAJOBS account and clicking on “Application Status.” For a more detailed update of your status, click on “more information.” Information regarding applicant notification points can be found in the USAJobs Resource Center.

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://www.vacareers.va.gov/why-choose-va/benefits/index.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

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. Per VA Handbook 5011: Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan CTAP) provide 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 85 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website

*Placement Policy: * The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement. Management may use any one or any combination of these methods to fill the position.

This job opportunity announcement may be used to fill additional vacancies.

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/476748100. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.

Open & closing dates: 2017-08-10 to 2017-08-23

Salary: $50,267 to $88,138 / per year

Pay scale & grade: VN 00

Series: 0610 Nurse

Appointment type: Permanent

Work schedule: Full Time

Job announcement number: OY-17-CSK-1998739-BU

Control number: 476748100