Job Summary

The primary purpose of this position is to evaluate clinical case reviews for the adequacy of care, compliance with clinical and regulatory guidelines, overpayment, and develop policy guidance for nursing care reviews conducted by State or Federal health facility surveyors. Incumbent acts as the onsite representative for Centers for Medicaid and Medicare. This position is located at the Chinle Service Unit, Division of Quality Management Department,Chinle, Arizona.

Job Description

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. 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. Licensure- For all grade levels and positions, applicants must have passed the National Council Licensure Examination. 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-11 and above grade level, many positions may require experience in a specialty area of nursing. Basic Requirements for the GS-12 (or equivalent) Grade Level In addition to the mandatory license and education described above under Basic Requirements applicants must have at least one or more full years of professional nursing experience that is equivalent to the next lower grade level. Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Provides clinical health outcome quality measures; evaluates clinical case reviews for adequacy of care; addresses problems and issues that involve complex matters as availability of program funding, staffing level, and distribution of program services; performs full range patient care duties and assesses medical legal implications for performing practice and activities; closely observes patients for conditions that require emergency measures. You must meet all qualification requirements within 30 days of the closing date of the announcement.