About the Position: This position is located at Naval Hospital Camp Pendleton, CA. The incumbent will serve as a Supervisory Nurse and be responsible for the integration of Utilization Management, Case Management, and Disease Management based on the Military Health Systems (MHS) Medical Management Model. A recruitment or relocation incentive may be authorized. Salary negotiation may be available for those candidates who are new to Federal service. This is a Direct Hire Solicitation
Who May Apply: US Citizens In order to qualify, you must meet the requirements described below. 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; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document. Basic Requirement for Supervisory Nurse (Consultant): Degree: 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. (Note: You must attach a copy of your transcripts.). Licensure: 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; and you must have passed the National Council Licensure Examination. Foreign Degree: A degree from a Foreign Nursing School. Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Exemption: You are exempt from the basic requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017, or before. Applicants claiming this exemption must meet the requirement below. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status. Degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed by the applicant. Active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. In addition to meeting the basic requirement above, to qualify for this position you must also meet the qualification requirements listed below: Professional Nursing Experience: One or more full years of professional nursing experience which includes identifying patients with complex health care needs, performing as a coordinator/liaison with providers, and ensuring healthcare services are within practice and access standards. This definition of professional nursing experience is typical of work performed at the next lower grade/level position in the federal service (GS-11). Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.
Implement and monitor the Utilization Management Program.
Develop, implement, and monitor recommendations to change or modify existing procedures, benefits, or policies to provide more cost effective, quality healthcare to eligible beneficiaries.
Coordinate/liaison with providers and staff to ensure that actual health care received is appropriate to meet the patient's needs.
Provide the communication link between the providers, staff, and civilian sectors regarding utilization review activities.
Review requests for patient care services within the Medical Treatment Facility (MTF) and civilian providers for conditions that require medical care.
Optimize continuing education to Medical Treatment Facilities on utilization review issues.
Interface with local, state, and federal agencies responsible for financing alternatives in healthcare, such as Medicare, Medicaid, and TRICARE Management Support Contractor those beneficiaries may be entitled to.
Identify problems with healthcare access and utilization in both the military and civilian sectors and recommends alternatives.
Supervise assigned employees performing professional work in nursing and allied healthcare services and to ensure that patients receive the appropriate care in the most efficient and cost-effective manner.