USAJOBS · 6 hours ago
Referral Management Program Administrator (O-6 Billet) Supervisory
Location Negotiable After Selection, USA
Full-time
Onsite
Mid, Senior Level
5+ years expUSAJOBS is seeking a Referral Management Program Administrator for the ICE Health Service Corps. The role involves overseeing referral coordinators, managing medical referrals, payment authorizations, and ensuring compliance with healthcare regulations.
ConsultingGovernmentHuman ResourcesInformation TechnologyInternetStaffing Agency
No H1B
U.S. Citizen Only
Responsibilities
Serves in the capacity of Referral Management Program Administrator (RMPA) and maintains subject matter expertise (SME) of the Referral Coordinator duties and responsibilities. Directly supervises Referral Management Leads (RMLs) and is the government technical monitor (GTM) related to contract staff within the RMP
As program administrator and SME, provides direct oversight of program activities, processes, and or policies related to: illegal alien off-site referrals, medical payment authorization requests, and related medical record acquisition, in support of and in collaboration with, all applicable IHSC services, divisions, units, programs and offices
Supports general billing and coding principles, medical claim resolution processes within HPMU, and provider recruitment initiation as applicable
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; utilizes quality control measures to ensure compliance; formulates and executes short and long-range plans for optimum utilization of personnel; oversees and provides training; and facilitates program equipment acquisition and property management as applicable
Overall responsibility for the successful planning, design, execution, monitoring, and management of the Referral Management Program (RMP) and related activities for referral/MedPARs for reimbursable health care services in collaboration with utilization management (UM), and medical claims for resolution. The RMP is of a nationwide scope and importance and is essential for ICE detainee healthcare and the IHSC mission
Develops and submits monthly, quarterly and annual reports ( i.e. strategic plan MAP/KPIs) training, Business Plan updates, quality assurance audits, etc. to the HPMU Unit Chief or designee. Serves as a liaison between IHSC, VAFSC, and ICE ERO components in coordinating outside community-based specialty care for illegal aliens. Coordinates and collaborates with internal and external stakeholders, including medical detention facility personnel, contractors, governmental and non-governmental public health entities
Incumbent ensures compliance with related IHSC, ICE, detention, and industry regulations, standards, processes, procedures, and policy as applicable; maintains records per policy; chairs meetings; and coordinates and or manages programs within immediate organizational component
Work purpose is primarily to further develop and maintain a standardized RMP; collaborate; supervise or provide government technical monitoring and oversight of government staff or contractor(s); advise, explain, interpret, and seek support for methods, policies and programs; and render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget)
As applicable, serves as supervisor or government technical monitor (GTM) of contractors or government employees (RMLs) in professional, technical, referral coordinator and or clerical roles in the conduct of all aspects of management (such as leave granting authority) of assigned functions related to administrative personnel management. Accountable for addressing staffing needs of the RMP in collaboration with IHSC Personnel Unit, IHSC contracting officer representatives (CORs), and ICE contracting officers (COs) to maintain adequate program staffing coverage that meets mission and accommodates for TDY and leave absences
Liaises regionally and or nationally with applicable internal and external stakeholders regarding processes, trainings, functions, and principles affiliated with the referral coordinator role, related HPMU program activities and duties as a GTM and or supervisor as applicable
Provides orientation and guidance to the respective ICE, custody, and medical staff (contractors or government employees) at facilities in which ICE illegal aliens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards
Judgmental failure 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 contract staff or subordinate employees, and compromise the delivery of other administrative and personnel services. Impact of error can cause serious impairment to a divisional/regional level program with a nationwide scope of importance
Incumbent responsibilities as a GTM are commensurate with the complexity, value, technical direction, and monitoring required for a given contract. The incumbent performs duties and complies with the responsibilities and limitations specified by the COR and contract specifications
Performs other duties and responsibilities as assigned
Qualification
Required
Minimum of a bachelor's degree in healthcare administration or related field of study preferred
Must have 5 years' experience or a minimum of two years' experience related to management, administration, or evaluation of public health or healthcare related programs
Healthcare management, health plan management, case management or utilization management is preferred
If the incumbent holds a clinical license, it is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain status including maintaining clinical professional skills via continuing education opportunities
Incumbent must possess at minimum a Level II COR, 40-hour course certificate or must obtain one 12 months from hire through the Defense Acquisition University (DAU) and Federal Acquisition (FAI) Cornerstone OnDemand (CSOD) online comprehensive learning platform
Incumbent must possess knowledge and skills in the areas of health plan operations, utilization management-specifically regarding the referral and authorization process, medical billing and coding, and medical claims processes
Ability to critically analyze situations, data and information, and be able to develop and pose probing questions, identify problems, and make recommendations towards their resolution
Knowledge of issues confronting the health care delivery system, including specific problems and concerns of special population groups
Flexibility and ability to adapt to sudden changes in schedules and work-related requirements
High degree of independence, initiative, and follow-through on a wide range of sensitive, complex, and program issues
Maintains CPR/BLS certification
Ability to communicate proficiently in English (verbal and written) in order to develop positive rapport with related stakeholders, chain of command, contractors, and staff
Ability to establish and maintain positive working relationships in a multidisciplinary environment
Ability to navigate in an electronic work environment including eHR, ICE web-based trainings and Microsoft Teams application navigation
Knowledge of and functional proficiency in Adobe and Microsoft Office programs, including but not limited to: Microsoft Word, Excel, Teams; Outlook and SharePoint
Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII)
Preferred
Supervisory experience preferred
Correctional or detention experience desired
Currently has or can achieve and maintain applicable certification as directed by IHSC through formal training and other means within 12 months of hire
Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements
Benefits
Comprehensive benefits package
Company
USAJOBS
USAJOBS enables federal job seekers to access job opportunities across hundreds of federal agencies and organizations.
10001+ employees
Funding
Current Stage
Late StageRecent News
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