Nurse (Utilization Management)

Summary About the Position: This position is with the Defense Health Agency, Womack Army Medical Center DIR OF Resource Management Managed Care This is a Direct Hire Solicitation Learn more about this agency Duties Conduct initial assessment of referrals based on clinical care provided, define clinical requirements for individual patients, and determine if the services requested are medically appropriate, cost effective, and provided in the appropriate setting. Assist providers with interpretation of guidelines and criteria for patient care, consult with providers to discuss and make decisions on issues involved in the continuum of care, and identify required actions as part of a multi-systems evaluation. Assist Health Benefits Advisors in resolution of the more complicated patient complaints regarding benefits, payment problems, and disputed claims. Assist Health Benefits Advisors in resolution of the more complicated patient complaints regarding benefits, payment problems, and disputed claims. Brief command and staff personnel on referral management activities, progress, and program requirements. Conduct review of existing policies and procedures and make recommendations on ways to improve referral management. Document and track information required to conduct referral management review and analysis including patient demographic data, clinical variances, cost avoidance relating to medical procedures and ancillary services, etc. Identify and develop sources of information from various automated and manual systems to be used to address specific areas of concern. Requirements Conditions of employment Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation. Applicants must be able to fulfill non-privileged professional credential requirements. Selectees will be required to sign a statement (Condition of Employment) consenting to seasonal influenza vaccinations or must provide a recognized exemption. A Personnel Security Investigation is required. Immunization screening is required. Hepatitis B immunization is required for all positions with direct patient contact. Applicants may be required to show proof of other immunizations depending on the type of position. This position is a Testing Designated Position subject to applicant testing and random drug testing. Selectees will be required to sign DA Form 5019 requiring participation in random drug urinalysis testing. Must be able to obtain and maintain current Basic Life Support (BLS) certification through the American Red Cross. Advanced certification (e.g., ALS) does not supersede BLS. Incumbent may be required to work any day or shift, including evenings, nights, weekends, and holidays. The position may also require an on-call status as necessary to meet mission requirements. Designated as Mission Essential and must assume Essential Personnel responsibilities during inclement weather, emergencies, or other situations requiring continuity of operations. Duties require moderate movement throughout the Military Treatment Facility (MTF) and off-site locations, as necessary. Significant travel may be required. This position requires completion of a pre-employment physical examination and compliance with annual physical requirements. One year probationary period may be required. Qualifications Who May Apply: US Citizens In order to qualify, you must meet the education and/or experience requirements described below. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document. Basic Requirement for Nurse (Utilization Management): Degree: A graduate or higher-level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. (Note: You must attach a copy of your transcripts.) Licensure: A current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States; and you must have passed the National Council Licensure Examination. Foreign Degree: A degree from a Foreign Nursing School. Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Exemption: You are exempt from the basic requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017, or before. Applicants claiming this exemption must meet the requirement below. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status. Degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed by the applicant. Active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. In addition to meeting the basic requirement above, to qualify for this position you must also meet the qualification requirements listed below: Education/Experience: A diploma, associate degree, or bachelor's degree in Nursing from a professional nursing program and possession of at least one full year of professional nursing experience (equivalent to the GS-09 grade level or above) which includes managing patient referrals, evaluating the quality or cost effectiveness of care, and educating patients or staff. OR Education: A PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field. Completion of all requirements for a doctoral degree (Ph.D. or equivalent) from a professional nursing program or 3 full years of progressively higher-level graduate education from a professional nursing program. Education See Qualifications section for education requirements. Additional information Male applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration. You will be required to provide proof of U.S. Citizenship. One year trial/probationary period may be required. Direct Deposit of Pay is required. Selection is subject to restrictions resulting from Department of Defense referral system for displaced employees. Recruitment or relocation incentives MAY be authorized for highly qualified candidates. Multiple positions may be filled from this announcement. Salary includes applicable locality pay or Local Market Supplement. Payment of Permanent Change of Station (PCS) costs is not authorized, based on a determination that a PCS move is not in the Government interest. Expand Hide  additional information 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 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. Review our benefits 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.