Summary This position is located at the Fort Belknap Service Unit in Harlem, MT. The purpose of this position is to provide case management/care coordination for patients requiring special health care needs. The incument reports to the Director of Nursing or designee. Responsibilities Review outpatient consultations/referrals to determine if referral meets established criteria of current priority level, monitor for alternate resources available, justification for services requested, and referral request. Collaborate with the Purchase Referred Care (PRC) department and medical providers to determine medical necessity and appropriateness of referral to make in house referrals when necessary. Monitor patient status, ensure primary care teams are notified of progress of patient referral and determine if services being delivered as planned. Respond to insurance providers and third party agencies to insure maximum reimbursement to minimize I.H.S costs on clinical issues. Maintain a tracking system for referred patients for admission to other healthcare facilities and perform chart reviews to determine timeliness of requested service to facilitate the return of patients to the service unit. Requirements Conditions of Employment Must pass pre-employment examination. Selectee may be subject to a probationary period U.S. Citizenship is required Selective Service Registration is required for males born after 12/31/1959 This is a designated position covered by Public Law 101-630, requiring contact or control over Indian children. Due to this requirement, the agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Adherence to the IHS Employee Immunization Policy, SGM 21-04, and the IHS Circular 2016-04 requiring Measles and Rubella, COVID-19, and seasonal influenza immunizations for staff working in Indian Health Service health care facilities OR an exemption request will need to be submitted. The selected individual is required to obtain and maintain medical staff clinical privileges, including any licensure requirements. If privileges are not obtained or maintained during employment, the employee will be subject to adverse actions, up to and including removal from Federal service. On-call hours or standby duty may be required. Successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit www.dhs.gov/E-Verify/. You will need to set up direct deposit so we can pay you. Background Investigation: If you are selected for this vacancy, you must undergo a pre-employment fingerprint check and background investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. After you begin your employment, your continued employment is contingent upon the outcome of a complete background investigation as determined by the sensitivity level of your position. The investigation must find that you are suitable for Federal employment in your position. If you are found not suitable, you will be terminated after you begin work. If you make a false statement in any part of your application, you may not be hired; you may be fired after you begin work; or subject to possible criminal charges. You may be subject to a credit check as a part of the background investigation process. Qualifications To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. 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; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. Individual Occupational Requirements NOTE: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. BASIC REQUIREMENTS Education 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. Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Licensure For all grade levels and positions, applicants must have passed the National Council Licensure Examination. In addition, they must possess 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. Experience The work experience must have equipped the applicant with the particular knowledge, skills, and abilities to successfully perform the duties of the position. At the GS-9 and above grade level, many positions may require experience in a specialty area of nursing. Basic Requirements for the GS-9 (or equivalent) Grade Level In addition to the above requirements, applicants must meet one of the following requirements: Possession of a master's degree in professional nursing; or At least one full year of professional nursing experience (equivalent to the GS-7 grade level or above) and possession of a diploma, associate degree, or bachelor's degree in Nursing from a professional nursing program. Basic Requirements for the GS-11 (or equivalent) Grade Level In addition to the above requirements, applicants must meet one of the following requirements: Successful completion of a PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field; or At least one full year of professional nursing experience (equivalent to the GS-9 grade level) and possession of a diploma, associate degree, bachelor's degree, or master's degree from a professional nursing educational program. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: GS-09: Review outpatient consultations/referrals to determine if referral meets established criteria of current priority level; monitor for alternate resources available; justification for services requested; and appropriateness of referral request. Maintain system for tracking referred patients for admission to other healthcare facilities and performs chart reviews to determine timeliness of requested service to facilitate the return of patients to the service unit. GS-11: Assisting and planning the coordination of the clinical component of managed care. Provide clinical and administrative recommendations relative to programs, committees and/or services that relate to fee senders and utilization management of patient referrals. You must meet all qualification requirements within 30 days of the closing date of the announcement. Education This position has an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer. Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.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. Additional Information Per IHS policy (SGM 21-04) IHS selectees to positions located in Federally operated hospitals, health centers, and clinics must be fully vaccinated for COVID-19 before entry on duty or have IHS approve a medical or religious exemption. If an exemption is approved then wearing a face mask and regular testing for COVID-19 will be required. Your Human Resources Specialist will provide a list of documents acceptable as vaccination proof and instructions on how to submit your vaccination documentation or how to request a medical or religious exemption, if needed. 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. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. This position is covered by a Bargaining Unit. Recruitment or relocation incentives may be authorized. At least a 12 month service agreement will be required. The Indian Health Service (IHS), National Health Service Corps (NHSC), and the Health Resources and Services Administration (HRSA) have student loan repayment programs for qualifying health disciplines. This is a competitive process separate from the hiring process. Opportunities for LRP are based on agency hiring priorities and availability of funds. For additional information please visit: For IHS - http://www.ihs.gov/loanrepayment/ For NHSC - https://nhsc.hrsa.gov/loanrepayment/