This position is located at the Kayenta Service Unit, Division of Quality Management, Quality Service Unit, Kayenta, Arizona. The Kayenta Health Center is a 13-bed short stay facility. The incumbent will serve as the Utilization Review Coordinator. The purpose of this position is to control costs, while monitoring the quality of patient care services.

Duties

The Nurse (CAM) - Utilization Review is the recipient of vital health care information that is critical to the care, treatment, and services rendered to the patient. The incumbent: Serves as a nurse specialist for the utilization review program. Will lead a team professionals that within the hospital setting to promote, coordinate, collaborate and on decisions based on pre and post admissions among a variety of health care providers (doctors, nurses, nurse practitioners, specialty and contract providers, nurse midwives, physical therapist, dieticians, pharmacists, medical social workers, and mental health practitioners). Reviews medical documentation, provide guidance to the medical coders to correct deficiencies to meet the established criteria from ICD-10, CPT, and HCPCS codes, and collaborates with the respective practitioner to ensure that documentation is corrected and appeal letters have been submitted to the State Quality improvement Organization or appropriate agency for case reconsideration of payment. Utilizes RN training and expertise to prevent denials by instructing and training the providers and staff regarding complete and appropriate medical documentation for the patient's status and level of care, and the documentation meets the facility Compliance Plan and all applicable guidelines, standards, and policies procedures. Actively participant in the Service Unit Purchase Referred Care Program and Professional Medical Care Rounds. Attends regularly scheduled managed care committee meetings. Applies professional knowledge and abilities to audit admitted/transferred charts lor appropriateness of admission, length of stay, and discharge planning. This position is being announced concurrently under ESEP/MP procedures. Please review vacancy announcement number IHS-24-KA-12344669-ESEP/MP; for eligibility requirements. NOTE: Applicants must apply separately for each announcement in order to be considered.

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): 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. Basic Requirements for the GS-11 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-11 Specialized Experience - Promotes the coordination, collaboration and continuity of care from admission to discharge, assesses the level of patient care needs, addresses the appropriateness of length of stay by ensuring patients meet medical necessity, provides education to clinical staff regarding third party payor requirements and medical liabilities; addresses denials from payors and pre-authorizations; monitors all admissions to meet regulatory requirements, including the coordination and collaboration with coding staff to meet internal control process; conducts and collaborates with inpatient care team related to discharge and case management. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). 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 https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Kayenta Service Unit PO Box 368 Kayenta, AZ 86033 US
• Name: Dori Sombrero
• Phone: 928-697-4391 X54391
• Email: [email protected]