Remote Utilization Review Rn Jobs in Louisville, KY

Summary
The incumbent serves as an Advanced Medical Support Assistant assigned to a Patient Aligned Care Team (PACT) model or a Specialty Care Setting involved in a PACT model. The PACT teamlet is a primary care team that generally consists of a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistanUhealth technician) and an administrative associate (MA/MSA/health technician).
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Duties
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Total Rewards of a Allied Health Professional
The Advanced MSA at a Community Based Outreach Clinic (CBOC) coordinates with the patient care team to review the clinic utilization by using various reports (e.g., Clinic Utilization Statistical Summary), ensure that the clinic setup is closely monitored to effectively support the needs of the clinic, and make any necessary adjustments; develop/maintain effective and efficient communication with the patient, interdisciplinary team, VA medical centers, and other agencies (e.g., assist with communications during the inpatient to outpatient discharge; communicate with non-VA medical facilities; facilitate/process secure messaging with the patient and team; notify patients of normal lab results; and develop and manage a tracking system for follow up care such as consults, tests, etc.).
Duties at this level include, but are not limited to:

• Participating in team huddles and team meetings to manage and plan patient care; setting priorities and deadlines, adjusting the flow and sequencing of the work to meet team and patient needs;
• Work with the team to reinforce the plan of care and self-help solutions and entering appropriate information into the electronic record;
• Monitoring pre-appointment requirements to assure readiness for patient visit, procedure (e.g., X-ray, lab work);
• Managing electronic wait list to verify and validate accuracy and resolve issues;
• Participating and providing input in problem solving on operational issues or procedures in team meetings, performing administrative follow up actions;
• Participating in and independently following up on team huddles by sharing information and collaborating with the medical team to assure continuity of care;
• Evaluating patient information and clinic schedule lists to determine whether patient is vested;
• Educating providers about shared patients (those who receive their care at multiple VAs or those who have care in the community) and bringing to the attention of the provider.

Work Schedule: 8:00am - 4:30pm, Monday - Friday
Recruitment Incentive (Sign-on Bonus): Not Authorized
Permanent Change of Station (Relocation Assistance): Not AuthorizedPay: Competitive salary and regular salary increases. When setting pay, a higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA (Above Minimum Rate of the Grade).
Paid Time Off: 37-50 days of annual paid time offer per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience.
Parental Leave: After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child.
Child Care Subsidy: After 60 days of employment, full time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66
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)
Telework: Not Available
Virtual: This is not a virtual position.
Functional Statement #: 40845-F
Permanent Change of Station (PCS): Not Authorized
Requirements
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Conditions of employment

• You must be a U.S. Citizen to apply for this job.
• Selective Service Registration is required for males born after 12/31/1959.
• Must be proficient in written and spoken English.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• Complete all application requirements detailed in the "Required Documents" section of this announcement.

As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

• your performance and conduct;
• the needs and interests of the agency;
• whether your continued employment would advance organizational goals of the agency or the Government; and
• whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
Qualifications
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.
Basic Requirements:

• Citizenship. Be a citizen of the United States (U.S.). Non-citizens may be appointed when it is not possible to recruit qualified citizens according to 38 U.S.C. § 7407(a).
• Experience. No experience required.
• Education. High school diploma, General Education Development equivalency certificate, or proficiency certificate from a State or territorial-level Board or Department of Education.
• Licensure/Certification/Registration. None
• English Language Proficiency. Candidates must be proficient in spoken and written English in accordance with 38 U.S.C. § 7403(f).

May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).
Grade Determinations: In addition to the basic requirements above, applicants must meet the following experience:
Experience. One year of experience equivalent to the GS-5 grade level. Examples of credible experience at this level include, but are not limited to: scheduling, canceling, re-scheduling patient appointments and/or consults; entering no-show information; monitoring appointment requests from multiple electronic sources; participating in huddles with other MSAs and/or clinic staff to determine the daily needs of the clinic, monitoring both inpatient and outpatient appointments in areas of responsibility; verifying and updating demographics and insurance information when patients check-in for appointments; coordinates administrative functions relating to emergency and non-emergency transfers to other clinical/medical facilities or private hospitals and determines appointment type based on the patient's eligibility status.
AND
Knowledge, Skills, and Abilities (KSAs) . In addition to the experience or education above, the candidate must demonstrate the following KSAs:

1. Advanced knowledge of the technical health care process (including, but not limited to, scheduling across interdisciplinary coordinated care delivery and/or care in the community models and patient health care portals) as it relates to access to care.
2. Advanced knowledge of policies and procedures associated with interdisciplinary coordinated care delivery and/or care in the community operational activities that affect patient flow, and patient support care administrative functions to include, but not limited to appointment cycles, outside patient referrals, follow-up care, overbooking, provider availability, etc.
3. Advanced knowledge of medical terminology due to the technical nature of language utilized by clinicians.
4. Ability to collaborate and communicate with a wide range of medical clinicians across multiple disciplines (e.g., medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting to ensure medical care to patients is met.
5. Ability to independently set priorities and organize work to meet deadlines, ensuring compliance with established processes, policies, and regulations.
6. Ability to communicate tactfully and effectively, electronically, by phone, in person, and in writing, with internal and external customers. This may include preparing reports in various formats and presenting data to various organizational levels, as well as resolving patient concerns.

Note: You must provide detailed information of your experience performed. Information such as "I was a Medical Support Assistant" is insufficient to determine your qualifications. Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hour worked per week.
Note: Quality of Experience. Qualifying experience must be at a level comparable to MSA experience or equivalent administrative clinical support role in a non-VA medical inpatient or outpatient setting at the next lower grade level. For all assignments above the full performance level, the higher-level duties must consist of significant scope, administrative independence, complexity/difficulty and a range of varieties.
Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.
The full performance level of this vacancy is GS-06. The actual grade at which an applicant may be selected for this vacancy is GS-06.
Physical Requirements: Typically, the Advanced Medical Support Assistant must be able to operate a computer terminal and be able to manage multiple activities at one time. Work is generally sedentary; however, there may be some walking, standing, bending, and carrying of light items. Work Environment: The work may be stressful due to the accelerated pace for several hours at a time during peak clinic hours or on days that have a large volume of clinic activity.
Education
There is no substitution of education for experience at this grade level.
Additional information
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. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.
During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.
This job opportunity announcement may be used to fill additional vacancies.
This position is in the Excepted Service and does not confer competitive status.
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.
If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.
Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
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Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.