This position is located in the Purchase Referred Care (PRC) of Jicarilla Service Unit. The primary responsibilities involve providing clinical case management support to the Purchase/Referred Care Program, coordinating healthcare service between inpatient/outpatient care teams, external entities, and PRC. This position reports to the Chief Nurse Executive. Area Nurse Recruiter: Olinka Foster (Albuquerque) Phone: 505-256-6730 or Email: Olinka.Foster@ihs.gov Area of Consideration: Government-Wide
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. BASIC REQUIREMENT(S):Education: A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing. 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. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS:GS-11: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-09 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: Serving as Clinical Liaison and Case Manager to coordinate and manage referrals for primarily uninsured and referral patients. Facilitates communication between clinical teams and outside agencies, conducting comprehensive assessments, and developing individualized care plans. Manages case consults, coordinating with service unit case managers and discharge planners, and arranging for discharge when services are no longer required. Knowledge of PRC regulations and interdisciplinary care planning. OR, possess a PhD or equivalent doctoral degree from a professional nursing educational program. You must meet all qualification requirements within 30 days of the closing date of the announcement.
**This position is being announced concurrently under Direct Hire Authority (DHA) procedures. Please review vacancy announcement number IHS-25-AQ-12781004-DHA; for eligibility requirements. NOTE: Applicants must apply separately for each announcement in order to be considered.** Serve as clinical liaison and resource for the staff for clarifying provider/referrals/orders; assists with the care coordination and care management of primarily uninsured patients/referrals can include some insured patient/referrals. Reviews the referrals daily assigning a medical priority rating utilizing the PRC Medical Priorities formulated by the Chief Medical Officer to staff to facilitate a seamless transition. Facilitates communication with the clinical staff and partners with the clinical care teams to ensure referrals are appropriate and timely. Co-Manages patient care needs with outside agency case managers and social workers of hospitalized patients that transition levels of care to ensure the patient receives the most cost-effective, appropriate and timely treatment. Develops a care and service delivery plan with the patient/family and interdisciplinary team (including service unit's and other non-IHS providers as appropriate) based on the needs identified and available provider and financial resources. Obtains needed services for patients through arrangement with service providers. Obtains prior authorization for patients covered by insurers who require prior approval. This includes being able to respond to clinical questions and/or required results which may be required to obtain approval and be able to coordinate denied claims for resubmission through appeals with additional medical or supporting information. Prepares patients, families, and providers for termination (discharge) from case management when services are no longer required. Arranges for any ongoing support/direct care services that the patient will need in coordination with service unit case managers and discharge planners, to include tribal entities when appropriate (i.e. tribal programs) Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Registered Nurse Total Compensation | Pay (ihs.gov)