Nurse (Case Management)

This position is located at the Western Oregon Service Unit in Salem, Oregon and Warm Springs Service Unit in Warm Springs, Oregon. The purpose of this position is to provide case management/care coordination for patients requiring special health care needs. The incument reports to the Director of Nursing or designee. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). Total Compensation Package • Check out IHS's outstanding total compensation package for this job: Registered Nurse Total Compensation | Pay (ihs.gov) Review outpatient consultations/referrals to determine if referral meets established criteria of current priority level, monitor for alternate resources available, justification for services requested, and referral request. Collaborate with the Purchase Referred Care (PRC) department and medical providers to determine medical necessity and appropriateness of referral to make in house referrals when necessary. Monitor patient status, ensure primary care teams are notified of progress of patient referral and determine if services being delivered as planned. Respond to insurance providers and third-party agencies to insure maximum reimbursement to minimize I.H.S costs on clinical issues. • Maintain a tracking system for referred patients for admission to other healthcare facilities and perform chart reviews to determine timeliness of requested service to facilitate the return of patients to the service unit. To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. 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; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. Individual Occupational Requirements NOTE: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. BASIC REQUIREMENT(S): Education 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(external link), Council on Accreditation of Nurse Anesthesia Educational Programs(external link), Accreditation Commission for Midwifery Education(external link), or an accrediting body recognized by the U.S. Department of Education(external link) at the time the degree was obtained. Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools (external link) is required for individuals who graduated from foreign nursing schools. Licensure For all grade levels and positions, applicants must have passed the National Council Licensure Examination(external link). In addition, they must possess 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. Experience The work experience must have equipped the applicant with the particular knowledge, skills, and abilities to successfully perform the duties of the position. At the GS-9 and above grade level, many positions may require experience in a specialty area of nursing. In addition to the above requirements, applicants must meet one of the following requirements: Basic Requirements for the GS-9 (or equivalent) Grade Level In addition to the above requirements, applicants must meet one of the following requirements: Possession of a master's degree in professional nursing; or At least one full year of professional nursing experience (equivalent to the GS-7 grade level or above) and possession of a diploma, associate degree, or bachelor's degree in nursing from a professional nursing program. Examples of experience include: Review outpatient consultations/referrals to determine if referral meets established criteria of current priority level; monitor for alternate resources available; justification for services requested; and appropriateness of referral request. Maintain system for tracking referred patients for admission to other healthcare facilities and performs chart reviews to determine timeliness of requested service to facilitate the return of patients to the service unit. Basic Requirements for the GS-11 (or equivalent) Grade Level Successful completion of a PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field; OR At least one full year of professional nursing experience (equivalent to the GS-9 grade level) and possession of a diploma, associate degree, bachelor's degree, or master's degree from a professional nursing educational program. Examples of experience include: Assisting and planning the coordination of the clinical component of managed care. Provide clinical and administrative recommendations relative to programs, committees and/or services that relate to fee senders and utilization management of patient referrals. You must meet all qualification requirements within 30 days of the closing date of the announcement. Selectee may be subject to a probationary period U.S. Citizenship is required Selective Service Registration is required for males born after 12/31/1959 This is a competitive vacancy announcement advertised under Direct Hire Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served, and all other Federal entitlements would remain the same. This is a designated position covered by Public Law 101-630, requiring contact or control over Indian children. Due to this requirement, the agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. The selected individual is required to obtain and maintain medical staff clinical privileges, including any licensure requirements. If privileges are not obtained or maintained during employment, the employee will be subject to adverse actions, up to and including removal from Federal service. Successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit www.dhs.gov/E-Verify/. You will need to set up direct deposit so we can pay you. Background Investigation Requirement: This position requires the successful completion of a federal background investigation as a condition of employment. A background investigation is a standard process used by the Federal Government to verify an individual's identity, employment history, education, and other relevant information to determine suitability for Federal service. Upon receipt of instructions, applicants must complete all required background investigation forms within five (5) calendar days of issuance. Timely completion is critical to avoid delays in processing or a determination of unsuitability. Applicants are strongly encouraged to prioritize this requirement and to maintain regular communication with their assigned Personnel Security Specialist throughout the process. Prior to the appointment, candidates must present two valid forms of identification. If one of the documents is a state-issued ID or driver's license, it must be REAL ID-compliant. This position has an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer. Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit https://sites.ed.gov/international/recognition-of-foreign-qualifications/.