Utilization Review Consultant (O-4 Billet) Non-supervisory

Full Job Description

Utilization Review Consultant oversees utilization management for ICE Health Service Corps, ensuring appropriate healthcare for detainees.

Duties include evaluating off-site services, mentoring staff, maintaining records, liaising with stakeholders, and ensuring compliance.

Requires clinical background, certification, and ability to analyze data. Travel and physical demands required. This position is only open to USPHS officers and Call to Active Duty (CAD) candidates.

COMPETENCIES: Strong oral/written communication skills.

Analytical Skills and ability to navigate complex systems Strong interpersonal and active listening skills Strong organizational and time management skills.

Demonstrates strong problem solving, judgment and decision-making skills. Demonstrates integrity/honesty and cultural competency. Demonstrates leadership and potential for advancement.

PHYSICAL DEMANDS: Required to walk unaided at a normal pace for up to 5 minutes and maintain balance. Required to jog/fast walk up to 1⁄4 mile.

Required to perform CPR/emergency care standing or kneeling.

Must have the ability to assist sick, injured, or aging detainees or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself).

Sitting and/or standing for extended periods of time [6-8 Hours]. Performing repeated bending motion. Average manual dexterity for computer operation. Phone use for extended periods of time.

Major Duties:

DUTIES AND RESPONSIBILITIES: Serves in the capacity of Utilization Review Consultant with the goal of becoming a subject matter expert in program activities and policies related to utilization review and management.

Must be able to perform recurring assignments with minimal direction or instructions; however, objectives, priorities and deadlines are provided on new assignments.

The incumbent possesses excellent judgment skills noting impact of error can cause impairment at department and program levels.

Duties include day to day management of utilization review workload and related processes for prospective, concurrent and retrospective reviews and prevention of fraud, waste, and abuse and include but are not limited to: Record Management Resolution of complex and time sensitive utilization related issues Collection, review, tracking, and reporting of UM related data on a local, regional, and national level Appropriately refers cases for high level of review and participates in Utilization Management Review Committee activities as needed Incumbent evaluates the efficacy and appropriateness of off-site community health services using national evidenced-based care guidelines, IHSC policies and detention standards, and clinical review outcomes.

Additionally, the incumbent maintains records per program policy, participates in meetings and program or collateral duties as assigned, and communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors.

Incumbent to function as a mentor and preceptor to other utilization review consultants (URC) and as a subject matter expert (SME) to internal/external stakeholders, referral coordinators and clerical employees regarding utilization review.

Provides coverage for other Utilization Review Consultants (URCs), and RUM if required, during TDY and leave absences.

Liaise with applicable internal and external stakeholders regarding utilization management (UM) processes, trainings, and principles to ensure inpatient stays are appropriate per evidence-based guidelines.

Provides orientation and guidance to the respective ICE, custody, and medical staff members of facilities in which ICE detainees are held regarding ICE policies, reporting requirements, and applicable ICE detention standards.

The incumbent selects his/her own methods and solves most normal problems arising during the course of work.

Completed work is usually evaluated for technical soundness, appropriateness and conformity to professional standards and compliance/regulatory requirements.

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 other staff, and compromise the delivery of other administrative and personnel services. Travel may be required - estimated 15%.

Travels TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs. Performs other duties and responsibilities as assigned.