Job Description
Summary This position serves as a Nurse functioning in the role of a Clinical Nurse Reviewer (CNR) within the Program Management Office (PMO), Veteran and Family Member Programs (VFMP) Directorate, Integrated External Networks (IEN), Integrated Veteran Care (IVC), Veterans Health Administration (VHA). The VFMP Directorate is responsible for developing, implementing, and managing a comprehensive quality assurance program focused on identifying, assessing, and mitigating program vulnerabilities. Responsibilities Major Duties: Conducts clinical reviews to determine medical necessity, service connection validation, and preauthorization requirements following VFMP and VHA policies. Evaluates utilization of health care benefits and assesses quality, efficiency, and appropriateness of care across VFMP programs. Accurately documents clinical review findings and ensures compliance with quality assurance, internal controls, and audit standards. Collaborates with interdisciplinary teams to clarif...