Indian Health Service Nurse Specialist (Utilization Review) in Crow Agency, Montana

Indian Health Service
1 vacancy in the following location:
  • Crow Agency, MT
Work Schedule is Full Time - Permanent

Opened Friday 10/14/2016 (6 day(s) ago)

** Closes Thursday 10/20/2016 (0 day(s) away)

Job Overview

Become a part of an innovative, dynamic, nationwide organization of dedicated health care providers working to meet the individual health care needs of American Indians and Alaska Natives. Indian Health Service (IHS) employees are considerate in our care, creative in our approach, enthusiastic about our work and compassionate with our patients.

Our lifestyle is adventurous, community oriented and focused on service and problem solving as part of a professional interdisciplinary team. Join us in improving the health outcomes of 2.2 million American Indians and Alaska Natives. This position is located within the Indian Health Service, Department of Quality Management, Crow Service Unit, Crow Agency, MT. The IHS is required by law to give absolute preference to qualified applicants who meet the Secretary of the Interior's definition of Indian for appointment to vacancies within the IHS in accordance with established IHS policy as outlined in the Indian Health Manual Part 7, Chapter 3. The IHS is an Equal Opportunity Employer. Applicants who do not fall under any of the categories listed on this vacancy announcement or are applying under ESEP and/or MPP may apply under the "Direct Hire Authority" by following the application instructions found on the Direct Hire Authority under Job Opportunity Announcement # IHS-17-BI-1823005-DH.

Reduced Area of Consideration: Per IHS Merit Promotion Plan 7-2.4 C, Management has determined that there is likely to be an adequate number of qualified applicants in the local commuting area. Non-Indian preference candidates outside this area will not be considered.


Conduct appropriate admission and concurrent review on all Title XVII (Medicare), Title XIX (Medicaid), and private insurance beneficiaries. Review the individual medical record documentation to determine appropriateness of admission/procedure and necessity on continued hospital care. Determine medical necessity and admission appropriateness using TJC and CMS approved criteria and UR policy to identify the need for continued hospitalization. Evaluate laboratory, radiology, pharmaceutical and other clinical data as well as the progress notes of physicians, and nurses.

Travel Required
  • Occasional Travel
  • Occasional travel may be required
Relocation Authorized
  • No
Job Requirements
Key Requirements
  • Selectee will be subject to a pre-employment fingerprint check.
  • Selectee will be subject to a background investigation.
  • Selectee will be subject to a probationary/trial period.
  • ESEP appointees typically serve two year trial period.
  • More than one selection may be made from this announcement.
  • U.S. Citizenship is required
  • Selective Service Registration is required for males born after 12/31/1959

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.

For positions requiring positive education requirements, or if you are using education to meet all or part of the qualification requirements, you MUST submit a copy of your transcripts or an itemized list of college courses which includes equivalent information from the transcript (course title, semester/quarter hours, and grade/degree earned) in your resume.

BASIC REQUIREMENT(S): Education: 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. (One year of nursing experience as a military corpsman that has been accepted by a State licensing body may be accepted in lieu of education at the GS-4 level.)

Registration: Applicants must have 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. An applicant who has graduated from an approved nursing educational program within the past 12 months may be appointed pending State registration as a professional nurse within 6 months of appointment. No person appointed pending registration may be retained beyond 6 months, or promoted, if registration has not been attained.

The following shows the amounts of education and/or experience required to qualify for this position:

GS-11: 1 year of specialized experience equivalent to the GS-9 grade level OR Completion of all requirements for a doctoral degree (Ph.D. or equivalent) or 3 full years of progressively higher level graduate education.

To qualify based on specialized experience for GS-11 level, you must have one year of experience (equivalent to the GS-9 level) that included duties such as:using an electronic health record to document patient care; experience with collecting, exporting, and analyzing data; conducting patient care reviews; worked in a leadership role; such as charge nurse, nurse supervisor, and/ or nurse executive. Work with the Business Office and HIM department in assuring all visits have proper and necessary documentation. The incumbent implements disease specific protocols for in the service unit as a way to standardize the care provided to patient by all medical providers. The incumbent will make daily rounds to meet newly admitted patient for assessment/referral of patients clinical needs, will also review chart for appropriateness, completeness and timeliness of documentation by providers and nurses. The incumbent will log all pre-certified cases, prospective payment cases, second opinions and monitors elective admission. The incumbent collects aggregates and interprets highly complex utilization review data; compiles and present statistical data to the Director of Quality, and will also serve as a member of the Quality Department. The incumbent will be responsible for keeping the Utilization Review plan up to date, providing recommendations for changes to meet new criteria. The incumbent will serve as resource person on regulations of all agencies involving Performance Improvement and reimbursement such as Joint Commission and Indian Health Service Manual. Coordinate and monitor compliance activities. Maintain current regulatory resources, ensures regulatory and policy updates regarding hospital -wide compliance

Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP).

You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: Thursday, October 20, 2016

Security Clearance

Public Trust - Background Investigation

Additional Information
What To Expect Next

You can track the progress of your application package via your USAJOBS account. You will receive an acknowledgement from USAJOBS that your submission was successful once we have received your on-line occupational questionnaire, resume, and any supporting documentation. You will be notified of the status of your application via your USAJOBS Account after we conduct a qualification review of your complete application package. You will be contacted if further evaluation or interviews are required. Any exaggeration of your experience, false statements, or attempt to conceal information may disqualify you for employment consideration. We may verify all information you provide in your resume and questionnaire responses, through reference and/or background check, and/or verification of your education. If you are selected, you will be contacted personally by the Human Resources (HR) office posting this announcement.

You will no longer need to call the HR Office to determine your application status. USAJOBS has added an alert setting to their system to provide status updates for applicants. You can elect to activate the status updates from your USAJOBS profile at any point during the application process.

If all required documentation is not submitted with your application you will lose consideration. It is the applicant's responsibility to verify that information and documents entered, uploaded, or faxed is received, legible and accurate. HR will not modify answers submitted by an applicant.

Indian Health Service is an Equal Opportunity Employer


You can review our benefits at

Other Information

This position meets the criteria specified in pillar number one of the five pillars of the PHS Commissioned Corps. PHS Commissioned Officers interested in performing the duties of this position with the Commissioned Corps MUST apply online under the merit promotion announcement indicated above in order to receive consideration. For more information on PHS Commissioned Corps, visit the website at: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which annual leave is earned. This position is covered by a Bargaining Unit. CONDITIONS OF EMPLOYMENT: Security Clearance: If you are selected for this vacancy, you must undergo a pre-employment fingerprint check and background investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. You will receive instructions on how to obtain and submit fingerprints and background investigation documentation. After you begin your employment, your continued employment is contingent upon the outcome of a complete background investigation as determined by the sensitivity level of your position. The investigation must find that you are suitable for Federal employment in your position. If you are found not suitable, you will be terminated after you begin work. If you make a false statement in any part of your application, you may not be hired; you may be fired after you begin work; or subject to possible criminal charges. Measles and Rubella immunization required for selectees born after 1957. Seasonal Influenza immunization is required for civilian health care facility staff working in Indian Health Service health care facilities. 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. IHS - Operated Properties are tobacco free

Salary Range: $69,081.00 to $84,624.00 / Per Year

Series & Grade: GS-0610-11/11

Supervisory Status: No

Who May Apply: Candidates eligible under Indian Preference appointing authority; All Federal employees serving on a career or career-conditional appointment; Reinstatement eligible; Veterans Preference including Veterans Employment Opportunities Act of 1998 (VEOA); Career Transition Assistance Plan (CTAP) eligible; Interagency Career Transition Assistance Plan (ICTAP) eligible; Schedule A, and/or PHS Commissioned Corps Personnel

Control Number: 453363900

Job Announcement Number: IHS-17-BI-1819897-ESEP/MP