NCCPAC Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM)

Summary

The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or VISN 12 while monitoring the revenue status for facilities through critically examining departmental operations and collaborating with the Nurse Manager regarding improvements. The RUR ANM relies on experience - education - and awareness of appropriate evidence-based practices for positive outcomes.

Qualifications

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 master's level bridge program in nursing who have completed coursework equivalent to a bachelor's 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.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification
• 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: https://apply.usastaffing.gov/ViewQuestionnaire/12825178
• Grade/Level Scope Education Nurse I - Level I Delivers fundamental - knowledge-based care to assigned clients while developing technical competencies
• An Associate Degree (ADN) or Diploma in Nursing - with no additional professional nursing required
• Nurse I - Level II Demonstrates integration of biopsychosocial concepts - cognitive skills and technically competent practice in providing care to clients with basic or complex
• An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I - Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required
• Nurse I - Level III Demonstrates proficiency in practice based on conscious and deliberate planning
• Self-directed in goal setting for managing complex client situations
• An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I - Level 2
• OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I - Level 2
• OR a Master's degree in nursing (MSN) and no additional professional nursing experience
• OR a Master's degree in a *related field with a BSN and no additional professional nursing experience
• Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• A BSN with 2 years of professional nursing equivalent to Nurse I - Level 3
• OR an MSN with one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Doctoral degree in Nursing with no professional nursing experience
• OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience
• Nurse III Executes position responsibilities that demonstrate leadership - experience and creative approaches to management of complex client care beyond the immediate practice setting
• MSN and 2 years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Master's degree in *related field with BSN and two years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• *Note: Foreign education programs/degrees are not creditable as related degrees
• Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: Physical demands of the work are generally minor - as the position requires sitting - standing - & walking
• Work is primarily sedentary
• May require prolonged standing - moderate walking - & manual dexterity
• Requires carrying light items - such as books - files - or laptop computer
• Must be in overall good health - able to sit at a desk working at a computer - engage in light to moderate physical activity including sitting - walking - bending - & carrying supplies
• This position also requires close visual acuity to perform an activity such as viewing a computer terminal - transcribing - reading & repetitive motions of the wrists - hands - and or fingers
• See VA Directive and Handbook 5019.

Duties

• The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly responsible for the oversite and leadership of staff and the department to accomplish business operations of the RUR team and the mission of the VA
• The RUR ANM is responsible for providing leadership and supervision to the RUR staff nurses who validate service connection (SC) and special authority (SA) eligibility and make decisions regarding authorization retrieval by third-party payers (TPPs)
• The ANM also serves as a resource to the Program Support Assistants (PSAs) role for retrieving authorizations and collaborating with staff nurses
• The RUR ANM possesses clinical and nurse leadership skills and demonstrates this through communication - mentoring and grade-appropriate critical thinking
• VA offers a comprehensive total rewards package: VA Nurse Total Rewards Responsibilities of the RN ANM include the following: * He/she is responsible to contribute to a safe - healthy working environment that supports the work of the RUR nursing unit and is influential in creating a professional nursing environment and fostering a culture where interdisciplinary team members are able to contribute to optimal program outcomes and grow professionally
• * He/she guides designated subordinates to collaborate among interprofessional 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 and external customers
• * The successful RUR ANM possesses expertise in leading people and creating change within the unit to support the mission of the VA
• * The RUR ANM's primary commitment is to the patient - whether an individual - family - group - or community (ANA Code of Ethics for Nurses)
• * Assist in Leading and organizing the RUR nursing program to ensure continuity of operations - peer accountability - organizational needs - and consistency in nursing practice * Reads and correctly interprets CPAC RUR policies - procedures - and guidelines to ensure staff compliance
• *Contributes to the RUR program through process improvement initiatives and RQC processes
• * Functions as a competent consultant in clinical practice to RUR staff - CPAC Leadership - and VA medical facilities regarding the Revenue Utilization Review procedures
• * Systematically evaluates current practice and formulates outcomes for groups of nurses - PSAs - patients - and/or organizational processes
• * Participates in establishing goals - solving problems - and collaborating with other departments both in the facility and in the CPAC to enhance the Revenue Utilization Review program
• * Work toward current and future software efficiencies to perform workload tasks
• * Possess the capability to learn data analytics to track - monitor and trend revenue recovery
• * Counsel and train staff on current and new processes while monitoring staff efficiencies
• * The RUR Assistant Nurse Manager must be an individual capable of working effectively in stressful situations and able to shift priorities based on organizational needs
• * The ANM functions as a supervisor and provides administrative and clinical supervision and general instruction - plans and assigns work - assigns time schedules - approves leave and completes performance evaluations for employees designated under their direct supervision
• * The ANM is self-directed and works under moderate supervision and instruction by the RUR Nurse Manager and Director
• 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 0800AM-1630PM Compressed/Flexible: Available at managements discretion Telework: Not Authorized Virtual: This is not a virtual position
• Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): Not Authorized