Referral Management Lead (O-5 Billet) Supervisory Job in Anywhere in the U.S. (remote job)

Vacancy No. IHSC-HPMU-RML-O5-S-2024 Department Immigration and Customs Enforcement
Salary $1.00 to $150,000.00 Grade 5 to 5
Perm/Temp Permanent FT/PT Full-time
Open Date 9/24/2024 Close Date 10/3/2024
Job Link Apply Online Who may apply Public
Locations:
Anywhere in the U.S. (remote job)


Job Description (Please follow all instructions carefully)

Summary

This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance (HCC), Health Plan Management Unit (HPMU). This is a supervisory position.

This position is only open to current USPHS officers.
USPHS Call to Active Duty (CAD) candidates are not eligible for this position.

This job is open to

Clarification from the agency

Applicants must be a current USPHS Commissioned Corps Officer. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.

Duties

DUTIES AND RESPONSIBILITIES:

  1. Serves in the capacity of Referral Management Lead (RML) for an assigned regional team and maintains subject matter expertise (SME) of the Referral Coordinator duties and responsibilities. As RML and SME, provides oversight of referral program activities, processes, and policies for facilities that house ICE noncitizens, related to off-site referrals, medical payment authorization requests, and related medical record acquisition, in support of and in collaboration with, all applicable IHSC services, divisions, units, programs and offices.
  2. Supports general billing and coding principles, medical claim resolution processes within HPMU, and provider recruitment initiation as applicable.
  3. Duties include day to day managing, assessing, planning, developing, implementing, and evaluating data (to include audits and data analysis), assigned activities, and processes. Incumbent reviews, revises, and, or writes policies for chain of command submission; provides government technical oversight of contract staff; utilizes quality control measures to ensure compliance; oversees and provides training; and facilitates program government furnished equipment (GFE) acquisition and property management as applicable. Provides oversight and consultation regarding MedPARs for reimbursable health care services and medical claims resolution.
  4. Incumbent ensures compliance with related IHSC, ICE, detention, and industry regulations, standards, processes, procedures, and policy as applicable; maintains records per policy; facilitates applicable meetings; coordinates and manages RC activities within their team region in collaboration with IHSC facility site leadership and local ICE Area of Responsibility (AOR).
  5. Work purpose is primarily to further develop and maintain a standardized Referral Management (RM) program; collaborate; supervise or provide government technical monitoring and oversight of government staff or contractor(s); advise explain, interpret, and seek support for methods, policies and programs; and render a service of a moderately complex nature requiring a moderate amount of explanation and tact.
  6. As applicable, serves as supervisor or government technical monitor (GTM) of contractors or government employees in professional, technical, referral coordinator and or clerical roles in assigned functions related to administrative duties. Accountable for addressing staffing needs of the RC Program within their AOR in collaboration with IHSC Personnel Unit, IHSC contracting officer representatives (CORs), ICE contracting officers (COs), and Task Order Three vendor management staff to maintain adequate program staffing coverage that meets mission and accommodates for planned and unplanned absences.
  7. Liaises locally and regionally with applicable internal and external stakeholders (including government and non-government officials) regarding processes, trainings, functions, and principles affiliated with the referral coordinator role, related HPMU program activities and duties as a COR or GTM and or supervisor as applicable.
  8. Provides orientation and guidance to the respective ICE, custody, and medical staff (contractors or government employees) at facilities in which ICE noncitizens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards.
  9. Judgmental failure can result in ineffective or inappropriate use of resources and delays on a local and departmental level. This may also impair the development of systems, affect the work of contract staff or subordinate employees, and compromise the delivery of other administrative and personnel services.
  10. Travel may be required - estimated 15%. Travels TDY as needed to include but not limited to program assessment or oversight, training or clinical support at detention facilities with or without staffing needs.
  11. Incumbent responsibilities as a government technical monitor (GTM) are commensurate with the complexity, value, technical direction, and monitoring required for a given contract. The incumbent performs duties and complies with the responsibilities and limitations as a GTM. As a GTM, the incumbent acts as technical liaison between the COR, the CO, and the Contractor with respect to monitoring the Contractor's performance against the contract Specification, Statement of Work (SOW), and Quality Assurance Surveillance Plans (QASP) and communicating any potential problems with the Contracting Officer.
  12. The incumbent provides position coverage for RMLs and for the RMPA, as applicable or as assigned.
  13. Performs other duties and responsibilities as assigned.

Requirements

Conditions of Employment

  • You must be a U.S. citizen to apply for this position.
  • You must successfully pass a background investigation.
  • You must successfully pass a drug screen.
  • Males born after 12/31/59 must certify registration with Selective Service.
  • Requirements by Closing Date: Unless otherwise noted, you must meet all requirements by the closing date of the announcement.
  • Service Remaining Requirement Agreement: Upon appointment to this position, officers will be required to serve an 18 to 24-month commitment to IHSC.
  • Applicants must be a current USPHS Commissioned Corps Officer. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.

Qualifications

PHYSICAL DEMANDS:
  1. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
  2. Required to jog/fast walk up to ¼ mile.
  3. Required to perform CPR/emergency care standing or kneeling.
  4. Must have the ability to assist sick, injured, or aging detainees or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself).
  5. Sitting and/or standing for extended periods of time [6-8 Hours].
  6. Performing repeated bending motion.
  7. Average manual dexterity for computer operation; able to endure the demands of consecutive hours of computer use and operation.
  8. Phone use for extended periods of time.

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

  1. Minimum of a bachelor's degree in healthcare administration or related field of study preferred. Must have 5 years' experience or a minimum of two years' experience related to management, administration, or evaluation of public health or healthcare related programs. Healthcare management, health plan management, case management, or referral management is preferred.
  2. If the incumbent holds a clinical license, it is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain current status including maintaining clinical professional skills via continuing education opportunities. The agency may require the incumbent performs clinical activities with the scope of clinical license in times of critical needs within the agency. If in a clinical discipline and as directed and approved by his/her supervisors, the incumbent may perform clinical duties of their profession in Federal health care facilities. Such direction is documented via a memorandum of assignment and is filed in the eOPF.
  3. Incumbent must possess at minimum a Level II COR, 40-hour course certificate or must obtain one 12 months from hire through the Defense Acquisition University (DAU) and Federal Acquisition (FAI) Cornerstone OnDemand (CSOD) online comprehensive learning platform.
  4. Incumbent must possess knowledge and skills in the areas of health plan operations, specifically regarding the referral and authorization process, medical billing and coding, and medical claims processes.
  5. Supervisory experience preferred.
  6. Correctional or detention experience desired.
  7. Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery and fraud, waste, and abuse.
  8. Currently has or can achieve applicable certification as directed by IHSC through formal training and other means within 12 months of hire.
  9. Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements.
  10. Ability to critically analyze situations, data and information, and be able to develop and pose probing questions, identify problems, and make recommendations towards their resolution.
  11. Knowledge of issues confronting the health care delivery system, including specific problems and concerns of special population groups.
  12. Flexibility and ability to adapt to sudden changes in schedules and work-related requirements.
  13. High degree of independence, initiative, and follow-through on a wide range of sensitive, complex, and program issues.
  14. Maintains CPR/BLS certification.
  15. Ability to communicate proficiently in English (verbal and written) in order to develop positive rapport with related stakeholders, chain of command, contractors, and staff and complete technical writing assignments as delegated.
  16. Ability to establish and maintain positive working relationships in a multidisciplinary environment.
  17. Ability to navigate in an electronic work environment including eHR, ICE web-based trainings and Microsoft Teams application navigation.
  18. Knowledge of and functional proficiency in Adobe and Microsoft Office programs, including but not limited to: Microsoft Word, Excel, Teams; Outlook and SharePoint. Possesses the ability to compile, edit, analyze, audit, and produce quality, meaningful work in reasonable timeframes within various software and computer solutions.
  19. Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).

Additional information

The incumbent reports directly to the IHSC Referral Management Program Administrator (RMPA).

Incumbent serves as a Referral Management Lead for IHSC Headquarters, within the HPMU's Referral Management Program (RMP). The Referral Management Program (RMP) is a national level program and is essential for ICE noncitizen healthcare and the ICE/IHSC/HPMU mission. As the Referral Management Lead (RML), the incumbent provides oversite of a regional team of IHSC's referral coordinator staff (contract and federal), the related referral and medical payment authorization requests (MedPAR) process for off-site medical services, supports related UM processes, supports related management of medical records, and supports related provider recruitment initiation and resolution of denied claims applicable to the referral process. HPMU programs focus on governance of the referral process for off-site medical services, a provider network, and claims adjudication and utilization management. HPMU staff collaborate with the Veterans Affairs Financial Services Center (VAFSC; a third-party medical claim administrator), and offsite providers to establish letters of understanding with IHSC. HPMU staff also work jointly with IHSC stakeholders: multiple units within the Clinical Services Division; Health Information and Technology Unit; Health Application Services Office; Records Management Office; Resource Management Unit; and IHSC headquarters to meet mission initiatives.

In FY 2023, IHSC administered and managed the health care system that provided direct care to more than 131,000 noncitizens housed at 18 IHSC-staffed facilities across the nation. The health care provided included medical, dental, mental health care, as well as public health and disease prevention programs. IHSC also oversaw compliance with ICE detention standards related to health care for more than 191,850 detained noncitizens housed in 128 non-IHSC-staffed facilities, totaling more than 45,000 beds.

SUPERVISORY CONTROLS:
The Referral Management Lead works under the supervision of the IHSC Referral Management Program Administrator. The incumbent plans & communicates regularly with the supervisor, organizes his/her own work, determines the sequence of assignments, selects and develops methods, seeks assistance from experts as required, and follows chain of command. Assignments are usually long-term, recurring, or broadly defined. Work is reviewed for feasibility, compatibility with other work, and effectiveness in meeting requirements or expected results.

Work is reviewed for attainment of objectives. Guidelines may be applicable to some but not to all parts of the assignment and may contain some inconsistencies and be partially unconfirmed. Selection and adaptation from available possibilities involving a moderate amount of modification and innovation is required. The officer uses judgment in interpreting and adapting guidelines such as PHS policies, regulations, precedents, and work direction for application to specific cases.

The officer analyzes results and recommends changes in guidelines and program policies. Innovations and modifications to accepted procedures must be approved and clearly documented. The officer keeps the supervisor informed of the status on projects and consults with him/her on any significant problems encountered.

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.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. You may be selected for an interview at the hiring authority's discretion. You will be notified of selection or non-selection.

Required Documents

To apply for this position, you must provide a complete Application Package. Please note that if you do not provide all required information, as specified in this announcement, you may not be considered for this position.A complete application includes:

U. S. Public Health Service Officers

  1. Cover Letter/Letter of Interest. Please include location preference here.
  2. Degrees. (Place under "Diploma/GED")
  3. Professional license. (If applicable)
  4. Additional professional certificates. (If applicable)
  5. Three professional references. (i.e., name, title and contact information)
  6. Official USPHS Promotion CV - e.g., relevant experience, education, training. (Place under "Resume")
  7. A copy of your Certificate of Investigation (located in your eOPF).
  8. *Three most recent Commissioned Officer Effectiveness Reports (COER). (Place under "Performance Appraisal")
  9. For current IHSC PHS officers, IHSC Recruiting requires applicants to provide a copy of your current Service Remaining Requirements Agreement.
  10. Indicate if you have an Assignment Pay (AP) Agreement and the date of the end of your AP Agreement.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

How to Apply

To apply for this position, you must submit the required documentation outlined under the REQUIRED DOCUMENTS section below.

The complete initial Application must be submitted by 11:59 PM (EST) on 10/03/2024.

PLEASE NOTE: If your materials are not received by the closing date, your application will be evaluated solely on the information available and you may not receive full consideration or may not be considered eligible. Also, if you do not provide a valid email address, you may not be notified of the outcome of your application.

To begin the process, click the Apply Online button to create an account or log into your existing USAJOBS account. Follow the prompts to complete the occupational questionnaire. Please ensure you click the Submit My Answers button at the end of the process.

Note: To check the status of your application or return to a previous or incomplete application, log into your USAJOBS account, select Application Status, and click on the more information link under the application status for this position.

Applications and supporting documentation will not be accepted by mail or email. If you need further assistance, contact the Human Resources Office representative listed on this announcement at least one day prior to the closing date for further instructions.

Agency contact information

IHSC Recruiting
Address
ERO-DRO-IHSC Public Health Service
500 12th Street SW
Washington, DC 20536
US
Learn more about this agency

Next steps

Once you submit your application, we will assess your experience and training, identify the best-qualified applicants, and refer those applications to the hiring manager for further consideration and interviews. We will notify you by email after each of these steps has been completed. Your status will also be updated on USAJOBS throughout the process. To check your status, log on to your USAJOBS account, click on "Application Status," and then click "More Information." We expect to make a job offer within 60 days after the deadline for applications. If you are selected, we will conduct a suitability/security background investigation. View more information on applying for federal employment.


Note: We cannot accept applications on behalf of Federal Agencies. Application instructions are listed within the Job Description.


© 2006-2024, exclusive of U. S. government job opportunity announcements