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This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance (HCC), Health Plan Management Unit (HPMU). The incumbent reports directly to the IHSC HPMU Unit Chief and is a supervisory position responsible for the Referral Management Program (RMP) and related activities. The RMP is a national level program essential for ICE detainee healthcare and the IHSC mission.

1. 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.
2. 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.
3. Supports general billing and coding principles, medical claim resolution processes within HPMU, and provider recruitment initiation as applicable.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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).
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. Performs other duties and responsibilities as assigned.

• You must be a U.S. citizen to apply for this position.
• You must successfully pass a background investigation.
• You must successfully pass a drug screen.
• Males born after 12/31/59 must certify registration with Selective Service.
• Requirements by Closing Date: Unless otherwise noted, you must meet all requirements by the closing date of the announcement.
• Service Remaining Requirement Agreement: Upon appointment to this position, officers will be required to serve a new 18-month commitment to IHSC .
• ASSIGNMENT PAY AGREEMENT: You must not have a current Assignment Pay Agreement. However, if you have a current Assignment Pay Agreement, it must be fulfilled within 90 days of your application submission.
• Applicants must be a current USPHS Commissioned Corps Officer who works at IHSC. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.
• PHS officers must participate in IHSC TDY On-Call Schedule (ITOS.) ITOS is either an entire month or two 16-day periods a year where, depending on the needs of the agency, the officer is required to be available to serve.

PHYSICAL DEMANDS:

1. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
2. Required to jog/fast walk up to ¼ mile.
3. Required to perform CPR/emergency care standing or kneeling.
4. 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).
5. Sitting and/or standing for extended periods of time [6-8 Hours].
6. Performing repeated bending motion.
7. Average manual dexterity for computer operation; able to endure the demands of consecutive hours of computer use and operation.
8. Phone use for extended periods of time.

1. 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.
2. 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. The agency may require the incumbent performs clinical activities with the scope of clinical license in times of critical needs within the agency. If in a clinical discipline and as directed and approved by his/her supervisors, the incumbent may perform clinical duties of their profession in Federal health care facilities. Such direction is documented via a memorandum of assignment and is filed in the eOPF.
3. 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.
4. 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.
5. Supervisory experience preferred.
6. Correctional or detention experience desired.
7. Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery and fraud, waste, and abuse.
8. Currently has or can achieve and maintain applicable certification as directed by IHSC through formal training and other means within 12 months of hire.
9. 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.
10. 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.
11. Knowledge of issues confronting the health care delivery system, including specific problems and concerns of special population groups.
12. Flexibility and ability to adapt to sudden changes in schedules and work-related requirements.
13. High degree of independence, initiative, and follow-through on a wide range of sensitive, complex, and program issues.
14. Maintains CPR/BLS certification.
15. Ability to communicate proficiently in English (verbal and written) in order to develop positive rapport with related stakeholders, chain of command, contractors, and staff.
16. Ability to establish and maintain positive working relationships in a multidisciplinary environment.
17. Ability to navigate in an electronic work environment including eHR, ICE web-based trainings and Microsoft Teams application navigation.
18. Knowledge of and functional proficiency in Adobe and Microsoft Office programs, including but not limited to: Microsoft Word, Excel, Teams; Outlook and SharePoint. Possesses the ability to compile, edit, analyze, audit, and produce quality, meaningful work in reasonable timeframes within various software and computer solutions.
19. Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).

This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance (HCC), Health Plan Management Unit (HPMU). The incumbent reports directly to the IHSC HPMU Unit Chief. This is a supervisory position.

Incumbent serves as the program administrator for IHSC Headquarters, within the HPMU's Referral Management Program (RMP). The RMP is a national level program and is essential for ICE illegal alien healthcare and the ICE/IHSC/HPMU mission. As the Referral Management Program Administrator (RMPA), the incumbent provides full oversite of IHSC\'s referral coordinator staff (contract and federal), the referral and medical payment authorization requests (MedPAR) process for off-site community medical services, supports utilization management (UM) processes, supports management of medical records related to referrals, supports provider recruitment initiation and resolution of denied claims applicable to the referral process. HPMU programs focus on governance of the referral process for off-site community medical services, a provider network, claims adjudication and utilization management. HPMU staff collaborate with the Veterans Affairs Financial Services Center (VAFSC; a third-party medical claim administrator), and off-site community providers to establish letters of understanding with IHSC. HPMU staff also work jointly with IHSC stakeholders: multiple units within the Clinical Services Division; Health Information and Technology Unit; Health Application Services Office; Records Management Office; Resource Management Unit; Field Medical Coordination Unit and IHSC headquarters to meet mission initiatives.

In Fiscal Year (FY) 2024, IHSC provided direct care to more than 138,000 illegal aliens housed in 18 facilities throughout the nation to include medical, dental, and mental health care, and public health services.

The Referral Management Program Administrator works under the supervision of the IHSC HPMU Unit Chief. The incumbent directly supervises RMLs, is the GTM over contract relations for the RMP, plans & communicates regularly with the HPMU Chief, organizes his/her own programmatic related work, determines programmatic workload and assignments, selects and develops methods, seeks assistance from experts as required, and follows chain of command.

Assignments are usually long-term, recurring, or broadly defined. Work is reviewed for feasibility, compatibility with other work, and effectiveness in meeting requirements or expected results.

Work is reviewed for attainment of objectives. Guidelines may be applicable to some but not all parts of assignment and may contain some inconsistencies and be partially unconfirmed. Selection and adaptation from available possibilities involving a moderate amount of modification and innovation is required. The officer uses judgment in interpreting and adapting guidelines such as PHS policies, regulations, precedents and work direction for application to specific cases.

The officer analyzes results and recommends changes in guidelines and program policies. Innovations and modifications to accepted procedures must be approved and clearly documented. The officer keeps the supervisor informed of the status on projects and consults with him/her on any significant problems encountered.

Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

You will be evaluated for this job based on how well you meet the qualifications above. We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. You may be selected for an interview at the hiring authority's discretion. You will be notified of selection or non-selection.

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

To apply for this position, you must provide a complete Application Package. Please note that if you do not provide all required information, as specified in this announcement, you may not be considered for this position. A complete application includes:

1. U. S. Public Health Service Officers
2. Cover Letter/Letter of Interest.
3. Degrees. (Place under "Diploma/GED")
4. Professional license. (If applicable)
5. Additional professional certificates. (If applicable)
6. Three professional references. (i.e., name, title and contact information)
7. Official USPHS Promotion CV - e.g., relevant experience, education, training. (Place under "USPHS Promotion CV")
   • You may provide a civilian resume in addition to the USPHS Promotion CV to capture all relevant work experience.
8. *Three most recent Commissioned Officer Effectiveness Reports (COER). (Place under "Performance Appraisal")
9. A copy of your current Service Remaining Requirements Agreement.
10. Indicate if you have an Assignment Pay (AP) Agreement and the date of the end of your AP Agreement. If you do not, please submit a memo attesting to no AP in the Assignment Pay (AP) Agreement section in the documents section of application.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from .

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.