The Regional Utilization Manager oversees ICE Health Service Corps utilization review, manages staff, ensures compliance with care guidelines, and liaises with stakeholders. Requires five years healthcare experience, two in management, and relevant degrees/certifications. Duties include program oversight, supervision, and policy development This position is only open to USPHS officers who are currently IHSC employees. USPHS Call to Active Duty (CAD) candidates are not eligible for this position
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 1⁄4 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. Phone use for extended periods of time.
DUTIES AND RESPONSIBILITIES: Serves in the capacity of Regional Utilization Manager and subject matter expert in the oversight of program activities and policies related to utilization review and management. Duties include day to day managing, assessing, planning, developing, budgeting, implementing, and evaluating assigned programs. Incumbent reviews, revises, and, or writes policies, provides technical oversight on contracts, formulates, and executes short- and long- range plans for optimum utilization of personnel, facilities and equipment. Incumbent ensures compliance with program regulations (e.g., appropriateness of health care and services based on regulatory, reimbursement requirements, evidence-based national care guidelines and evidence-based practices), maintains records per program policy, chairs meetings, and manages programs within immediate organizational component. Communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. Work purpose is primarily to collaborate; supply advice; explain, interpret and seek support for methods, policies and programs; or render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget). Supervises utilization review consultants (URC), in all aspects of management, conduct, and assigned functions. Reviews and approves URC leave, training, and travel requests. Provides oversight and consultation to URCs regarding referrals (also known as Medical Payment Authorization Requests; MedPARs) and medical claims review. Ensures subordinate staff provide adequate coverage (e.g., TDY and leave absences). Liaises regionally and, or, nationally with applicable internal and external stakeholders (e.g., Customs and Border Patrol, TPA) regarding utilization management (UM) processes, trainings, and principles to ensure inpatient stays are appropriate per evidence- based guidelines. Provides orientation and guidance to the respective ICE, custody, and medical staff members within facilities where ICE detainees are housed regarding ICE policy, reporting requirements, and applicable ICE detention standards. Utilize critical thinking and wise judgement; failure to do so can result in ineffective or inappropriate use of resources and delays in meeting public health objectives of the office or agency. This may also impair the development of systems, affect the work of subordinate employees, and compromise the delivery of other administrative and personnel services. Travel as required - estimated 15%. Travels TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs. Performs other duties and responsibilities as assigned.