This position is located in the Purchased Referred Care (PRC) Department at the Phoenix Indian Medical Center, in Phoenix, AZ. The incumbent provides clinical case management support to the PRC Program by identifying appropriate providers and facilities throughout the continuum of services, while ensuring available resources are being used in a timely and cost-effective manner to obtain optimum value for the patient, PRC, and the provider. Reports to the Inpatient Case Management Supervisor.

Duties

Primary responsibility, with PRC authority to authorize and coordinate all Inpatient STAT Referrals. Communicates with all multi-disciplinary team members, including Inpatient Case Management team members. Serves as clinical liaison and subject matter expert on durable medical equipment, prosthetics, and orthotics per Center for Medicare and Medicaid Services (CMS) documentation requirements. Provides guidance as related to CMS regulations to ordering providers, PRC Staff, and all other members of the healthcare team. Reviews emergency room (ER) notifications received from private facilities, coordinates care with members of the healthcare delivery team to ensure patients receive follow-up care in a timely manner; utilizes secure electronic access to health care facilities that provide services to our patients. Compliant to the Health Insurance Portability and Accountability Act (HIPPA) laws and regulations while using secure electronic access. Manages and triages referral repository from other Indian Health Service facilities, Tribal Health Centers, and Urban Indian Health Programs for PIMC specialty services. Triages or screens patients (identified through the triage line, referred by other case managers outside of IHS) that require case management intervention; referral authorization, payment decisions, clarification of orders, identification of primary care provider, transition of care, and other identified needs. Completes a comprehensive assessment or coordinates patient assessments with the interdisciplinary care teams. Documents the patient's condition and situation, including updating patient demographics, medical/physical/functional status, mental/emotional/behavioral status, environment, financial resources and support systems. Synthesizes presented data to develop a comprehensive plan with the patient/family and interdisciplinary team (including other IHS service units or other non-IHS providers) based on identified needs and available resources. Develops transition care plan that provides the best continuity of care for the patient/family; care teams are notified and continued care plan is established.

Requirements

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. BASIC REQUIREMENT(S): Note: Employees currently assigned to positions in this 0610 occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. 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, OR 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. In addition, to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS, GS-0610-11: 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: Developing a tracking system for patient care coordination and care management across the continuum; independently plans and provides nursing care based on professional nursing practices and medical protocols or guidelines for patients; collaborating with the physicians to develop clinical protocols and guidelines that establish standards of care; providing case management for patients by coordinating services to meet patient's care goals; providing oversight to ensure compliance and appropriateness of care. OR Completed a PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field. (Must provide evidence with your application if qualifying using this option.) You must meet all qualification requirements by 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.

Contacts

• Address Phoenix Service Unit 1616 E Indian School Rd Suite 360 Phoenix, AZ 85016 US
• Name: Chelsea Banteah
• Email: [email protected]