Referral Management Lead (O-5 Billet) Supervisory

Department of Homeland Security - Immigration and Customs Enforcement • Anywhere in the U.S. (remote job)

Company

Department of Homeland Security - Immigration and Customs Enforcement

Location

Anywhere in the U.S. (remote job)

Type

Full Time

Job Description

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.

Learn more about this agency

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:

Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
Required to jog/fast walk up to ¼ mile.
Required to perform CPR/emergency care standing or kneeling.
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).
Sitting and/or standing for extended periods of time [6-8 Hours].
Performing repeated bending motion.
Average manual dexterity for computer operation; able to endure the demands of consecutive hours of computer use and operation.
Phone use for extended periods of time.

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

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.
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.
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.
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.
Supervisory experience preferred.
Correctional or detention experience desired.
Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery and fraud, waste, and abuse.
Currently has or can achieve applicable certification as directed by IHSC through formal training and other means within 12 months of hire.
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.
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.
Knowledge of issues confronting the health care delivery system, including specific problems and concerns of special population groups.
Flexibility and ability to adapt to sudden changes in schedules and work-related requirements.
High degree of independence, initiative, and follow-through on a wide range of sensitive, complex, and program issues.
Maintains CPR/BLS certification.
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.
Ability to establish and maintain positive working relationships in a multidisciplinary environment.
Ability to navigate in an electronic work environment including eHR, ICE web-based trainings and Microsoft Teams application navigation.
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.
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.

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.

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Date Posted

09/30/2024

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