Purchase Referred Care (PRC) Office Administrator - Indian Health Service

Summary Oversees a specialized funding program for a health care center on the Confederated Tribes of the Colville Indian Reservation. The program assists patients in funding health needs beyond that available at the center. Work includes analyzing effectiveness of program, ensure available funding, regular reports and supervise others who pay claims. This job announcement is OPEN UNTIL FILLED. Job announcement closes once the position is filled. Recruitment or relocation incentives may be paid. Responsibilities Visit the website for information on the Indian Health Service Agency special funding program called Purchasing/Referral Care (PRC). The website provides information to American Indian/Alaska Native (AI/AN) patients on the PRC program requirements for medical/dental care. Major duties of the Purchase, Referred Care Office (PRC) Administrator: Develop management systems to provide effective and appropriate complex paperwork systems necessary to process thousands of individual cases in accordance changing requirements. Supervises the PRC program staff. Provides to the Chief Executive Officer or Deputy Chief Executive Officer and the PRC Committee a weekly spending plan. Responsible for the sound fiscal management of the PRC Program. Makes determinations and develops policies regarding the extent of service unit participating in costs of medical care for authorized clients. Develops for submission any potential Catastrophic Health Emergency Fund cases. Carries out necessary work to ensure the maximum utilization of alternate resources for major and non-routine cases. Makes efforts to develop other programs and locate other resources to fill unmet health needs due to limitations of the PRC funding. Works with others in development and operation of a variety of health service contracts with local hospitals, clinics, individual consultants, pharmacies, locum agencies to maximize the service and cost effectiveness of health services. Interprets the PRC Program to patients/consumers, partners, and vendors in accordance with appropriate laws, regulations and policies. Trains or meets on regular basis with participating health care providers. Formulates service unit budget requests for contract services. Provide data for the CSU budget formation for the Governing Board. Identifies significant deviations from the approved IHS National and PAO direction projected plans, complies supportive data; revises budgetary requirements and writes requests for budget adjustments for the review and formal presentation to the CEO when supplemental funds are required. Participates on national committees to remain current on the PRC program operations. Requirements Conditions of Employment 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 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. Measles and Rubella immunization required for selectees born after 1957 and seasonal influenza immunization is required for all staff working in Indian Health Service health care facilities. COVID-19 vaccination is required for all selectees prior to entrance on duty. 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: 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. 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. You may be subject to a credit check as a part of the background investigation process. Qualifications 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. MINIMUM QUALIFICATIONS FOR GS-11: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the grade GS-09, which is 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 such as: work experience in managing a program that includes the accounting of money accounts reporting and maintenance, and the processing of claims for the government health facility or private health insurance group. OR Submit a copy of unofficial transcripts to show completed a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or LL.M., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. OR Demonstrate meeting qualifications for this grade level by indicating on resume and submitting a copy of unofficial transcripts to show a combination of specialized experience and graduate level education that meets 100% of the qualification requirements for this position. Specialized Experience: Experience that equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled. You must meet all qualification requirements within 30 days of the cut-off date or the closing date of the announcement. The first cutoff date is 10 days after the opening date. If necessary, additional cutoff dates will be established until the position is filled. Once the position is filled, the job announcement closes. Education Substitution of Education for Experience or Combing Education with experience to qualify for the GS-11 grade is a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or LL.M., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. Graduate Education: Education at the graduate level in an accredited college or university i meets the requirements for positions at GS-7 through GS-11. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended. Additional Information Per IHS policy (SGM 21-04) IHS selectees to positions located in Federally operated hospitals, health centers, and clinics must be fully vaccinated for COVID-19 before entry on duty or have IHS approve a medical or religious exemption. If an exemption is approved then wearing a face mask and regular testing for COVID-19 will be required. Your Human Resources Specialist will provide a list of documents acceptable as vaccination proof and instructions on how to submit your vaccination documentation or how to request a medical or religious exemption, if needed. This position is eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy. https://www.hhs.gov/about/agencies/asa/ohr/hr-library/990-1/index.html. Additional selection(s) of candidates may be possible within 240 days from the date the certificate of eligibles was issued for this announcement. 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 they earn annual leave. Recruitment or relocation incentives may be authorized. At least a 6 month service agreement will be required.