Supervisory Health System Specialist (PRC)

This Supervisory Health System Specialist (PRC) position is with Indian Health Service (Department of Health and Human Services) in Phoenix, AZ. This position is organizationally located in the Purchased and Referred Care (PRC) program at the Phoenix Indian Medical Center (PIMC) located in Phoenix, AZ. The purpose of this position is to provide support and technical assistance to the Service Unit management on matters involving processing PRC Referrals. Serves as the Supervisor of the Referrals section within the PRC program. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). Key duties: • Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Health System Specialist Total Compensation | Pay (ihs.gov) Manages and oversees Purchased/Referred Care and related programs, ensuring compliance with IHS policies, coordinating with leadership, and advising on program operations, regulatory requirements, and strategic planning. Leads program improvement and stakeholder engagement, implementing quality controls, managing appeals and claims, educating patients and partners, and maximizing use of alternative resources to enhance program effectiveness and compliance. Oversees high-risk case management, ensuring eligibility compliance, timely reporting, effective referral coordination, and providing guidance, education, and oversight to support managed care processes. Directs and supervises program staff and operations, overseeing work planning, assignments, performance management, hiring, training, and employee relations while improving productivity, maintaining quality standards, and ensuring effective program execution. 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. BASIC REQUIREMENTS - INDIVIDUAL OCCUPATIONAL REQUIREMENTS - Education: Undergraduate and Graduate Education Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR; Specialized Experience - Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following; OR Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. Special Provision for In-service Placement: Successful complete of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: GS-12: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level (GS-11) in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: coordinating patient care through referred care systems; analyzing, monitoring and forecasting program funds; ensuring third party resources are utilized effectively; processing and coordination of Catastrophic Health Emergency Fund (CHEF) cases; issuing and reconciling purchase orders; assisting in coordination of case management; conducting vendor outreach efforts and negotiating referred care vendor contracts; ensuring compliance with eligibility requirements and establishing proper medical priorities for referred care; long and short range program planning; establishing and implementing performance improvement goals. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). You must meet all qualification requirements within 30 days of the closing date of the announcement. View the full announcement and apply on USAJOBS.gov.