• Performs pre-admission, throughout course of hospital stay, and pre/post-discharge administrative clinical review of all electives, urgent, and emergency admissions for which the program is responsible.
• Determines necessity of continued hospitalization by concurrent review of patient records, consultation with physicians, and conducting level of care analysis utilizing pre-established criteria, policy.
• Communicates this information to the multidisciplinary team and physician; provides consultative expertise in recommending the most appropriate level of care setting for patients with specialized needs and complex health care requirement.
• Coordinates and /or performs case management for TRICARE beneficiaries during use of MTF facility services.
• Plans, organizes, coordinates, and monitors a variety of multidisciplinary services to ensure access to appropriate, timely, quality, and cost-effective care and follow-up.
• Responsibilities include case management consultation and /or services for beneficiaries or other patients who are hospitalized at the MTF or beneficiaries at local civilian hospitals.
• Coordinate with external DoD, Federal and civilian health care facilities to ensure proper transition of care and transfer of patients

Conditions of employment

• Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.
• This position requires rotating shift work to provide coverage on evenings, weekends, holidays, or special situations.
• This position is subject to a pre-employment drug screening, and random drug testing thereafter, to include testing based on reasonable suspicion and testing due to direct involvement with an on-duty accident.
• This position has a mandatory seasonal influenza vaccination requirement and is therefore subject to annual seasonal influenza vaccinations.
• This position requires travel up to 5% of the time.
• This position has been designated "Mission Essential." The incumbent must report to or remain at work, even during natural or man-made disasters.
• The incumbent must obtain and maintain Basic Life Support (BLS) certification.
• This position has a Pre-employment and annual physical requirement.
• This position requires regular contact with children under the age 18 and a favorable determination of suitability to do so. Childcare background check required.
• Employees assigned to a medical treatment facility are required to be screened for applicable immunizations or pre-existing immunity based on occupational risk, regardless of job series.
• Appointment to this position is subject to a one year probationary period unless the appointee has previously met the requirements as described in 5 CFR Part 315.

Qualifications

Who May Apply: US Citizens

In order to qualify, you must meet the education and experience 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 Nurse (Utilization Management):

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.

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: At least one full year of professional nursing experience which includes coordinating with clinical staff for case management and/or discharge planning and performing medical record reviews for pre-admission, admission, and/or continued stays. This definition of professional nursing experience is typical of work performed at the next lower grade/level position in the federal service (GS-09).

OR

Education: Successful completion of a PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field.

How you will be evaluated

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

Once the announcement has closed, a review of your application package (resume, supporting documents, and responses to the questionnaire) will be used to determine whether you meet the qualification requirements listed on this announcement.

If, after reviewing your resume and/or supporting documentation, a determination is made that you have inflated your qualifications and/or experience, you may lose consideration for this position. Please follow all instructions carefully when applying, errors or omissions may affect your eligibility.

You should list any relevant performance appraisals and incentive awards in your resume as that information may be taken into consideration during the selection process. If selected, you may be required to provide supporting documentation.

Veterans and Military Spouses will be considered along with all other candidates.