Rn Insurance Claims Remote Jobs in Springfield, MA

Summary
This Registered Nurse (Risk Manager/ Quality Management Specialist) position is in Quality and Patient Safety services at the VA Central Western Massachusetts, located at the Leeds, MA, location. This position is a permanent, full-time at 40 hours per week.
NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below
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Duties
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NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below.
The RN Risk Manager/ Quality Management Specialist position is located in the Quality Management Department and reports to the Chief of Quality Management. The incumbent is responsible for oversight and management of the Enterprise Risk Management Program, which includes an integrated set of activities to systematically identify, evaluate, reduce and/or eliminate, and monitor the occurrence of adverse events and situations arising from operational activities and environmental conditions.
Duties include but are not limited to:

• Assuming responsibility for the Enterprise Risk Management Program elements: ABI, occurrence screen review and processing, tort claim processing for legal counsel, peer review assistance to the Chief of Staff (COS), risk assessments, policy and procedures.
• Administering the program on a day to day basis, managing, interpreting, and analyzing risk data; providing risk management education to members of the healthcare team
• Assuring compliance with regulatory standards and directives regarding risk management
• Conducting investigations, audits, problem focused studies which includes record reviews, collecting relevant data, analyzing all aspects and making recommendations to mitigate risks
• Assisting with aspects of the patient safety program which effect or overlap the risk management program
• Participating in relevant hospital committees and functions
• Advising/consulting with management to ensure that the results from analysis of risk management activities are fully integrated in the overall QI program
• Ensuring there is an effective process for monitoring and trending of all risk management activities and reporting to designated hospital committees and leadership
• Maintaining and enhancing current knowledge of risk management principles relative to healthcare delivery

Work Schedule: Monday-Friday, 8:00am to 4:30pm
Telework: Yes, may be authorized as determined by the agency policy at an Ad-hoc basis
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized
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
Notifications:

• This position is in the Excepted Service.
• This position is covered by a special rate.
• This position is NOT a Bargaining Unit Position
• The salary is based on the grade and step approved for the selected candidate.
• Veterans' preference does not apply for internal or other current permanent Federal agency employees.
• The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below
• If you are a current federal employee, you are required to attach your Most Recent non-award SF-50. This should be a SF-50 from the current calendar year which shows your current position, grade and step. Award SF-50's do not provide sufficient information and will not be accepted.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards
Requirements
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Conditions of employment

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• Selective Service Registration is required for males born after 12/31/1959.
• 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.
• Must pass pre-employment physical examination.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• You may be required to serve a probationary period.
• Complete all application requirements detailed in the "Required Documents" section of this announcement.

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/13029464.
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.
Preferred Experience:

• 1-2 years of Quality Management or Risk Management
• Bachelor of Science in Nursing (BSN)
• Strong Communication, collaboration and interpersonal skills
• Experience with program management, patient safety, root cause analysis and risk analysis

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.
Physical Requirements: All applicants must be physically able to satisfactorily perform the duties of the position. A pre-placement physical examination shall be completed prior to appointment.
Education
Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. 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. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.The Associate Degree Nursing (ADN), Bachelor of Science degree in Nursing (BSN), or Master of Science degree in Nursing (MSN) must be fully accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission On Collegiate Nursing Education (CCNE). Verification of accreditation may be obtained from http://www.acenursing.us/accreditedprograms/programsearch.htm or https://directory.ccnecommunity.org/reports/accprog.asp.

• If your school has changed names, or is no longer in existence, you must provide this information in your application.
• If your school was accredited by ACEN or CCNE at the time of graduation, but is no longer listed on the websites, you must provide documentation of accreditation with your application packet.

Additional information
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 Con