Regional Utilization Manager (O-5 Billet) Supervisory

DUTIES AND RESPONSIBILITIES: Serves in the capacity of Regional Utilization Manager and subject matter expert in the oversight of program activities and policies related to utilization review and management. 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, formulates, and executes short- and long- range plans for optimum utilization of personnel, facilities and equipment.

Incumbent ensures compliance with program regulations (e.g., appropriateness of health care and services based on regulatory, reimbursement requirements, evidence-based national care guidelines and evidence-based practices), maintains records per program policy, chairs meetings, and manages programs within immediate organizational component. Communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. Work purpose is primarily to collaborate; supply advice; explain, interpret and seek support for methods, policies and programs; or render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget).

Supervises utilization review consultants (URC), in all aspects of management, conduct, and assigned functions. Reviews and approves URC leave, training, and travel requests. Provides oversight and consultation to URCs regarding referrals (also known as Medical Payment Authorization Requests; MedPARs) and medical claims review.

Ensures subordinate staff provide adequate coverage (e.g., TDY and leave absences). Liaises regionally and, or, nationally with applicable internal and external stakeholders (e.g., Customs and Border Patrol, TPA) 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 within facilities where ICE detainees are housed regarding ICE policy, reporting requirements, and applicable ICE detention standards.

Utilize critical thinking and wise judgement; failure to do so 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 subordinate employees, and compromise the delivery of other administrative and personnel services. Travel as 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.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: Incumbent must possess a minimum of five years of professional experience relevant to the officer's category. Of the total professional experience, officer must possess at least two years of experience related to management, administration, or evaluation of public health programs. Healthcare management or utilization management is preferred.

Meet the minimum education requirements for either a nurse, nurse practitioner, or physician assistant. Nurse. Must possess a qualifying bachelor's degree in nursing or a master's degree in nursing (with no qualifying bachelor's degree) accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

Master's degree is preferred. Nurse practitioner. Must possess a certified advance practice nurse practitioner degree from a graduate school training program approved for this qualifying degree. Physician assistant.

Must possess an accredited bachelor's or master's degree and have completed a physician assistant training program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), and national certification through the National Commission on Certification of Physician Assistants (NCCPA). Master's degree is preferred. Incumbent must possess utilization management guideline certification or obtain certification within 12 months of hire.

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. 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. Possesses well-developed knowledge and skills in the areas of utilization management (and/or case management) and medical necessity. Supervisory experience preferred.

Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery. 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. 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.

Maintains clinical professional skills via continuing education opportunities. Maintains CPR/BLS certification. Have professional background in health care with extensive direct patient care experience, preferably within a correctional setting.

Computer literate on Adobe and MS Office applications.

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.

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, Health Plan Management Unit (HPMU). The incumbent reports directly to the IHSC Utilization Management Program Administrator (UMPA). This is a supervisory position.

The HPMU Utilization Management Program (UMP) is a national level program, essential for ICE detainee healthcare and the ICE/IHSC/HPMU mission. HPMU UMP collaborates with the third-party administrator (TPA) for claims processing and IHSC stakeholders to meet mission initiatives. UMP evaluates the efficacy and appropriateness of off-site community health services, based on MCG Care Guidelines, IHSC policies, and detention standards; evaluates clinical review outcomes; maintains records per program policy; chairs meetings; and manages programs within their organizational component.

UMP communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. In Fiscal Year (FY) 2025, IHSC provided medical services to more than 171,000 detained aliens housed in 17 facilities throughout the nation. In FY 2025, IHSC oversaw compliance with health-related standards for over 266,000 detained aliens housed in 217 non-IHSC-staffed facilities, totaling over 50,700 beds.

IHSC Headquarters provides guidance and support to IHSC-staffed facilities. While IHSC does not directly provide medical services in non-IHSC-staffed facilities, IHSC audits the facilities' compliance with national detention standards, as required by each facility's contract with ICE. SUPERVISORY CONTROLS: The Regional Utilization Manager works under the supervision of the IHSC Utilization Management Program Administrator.

The incumbent plans and organizes his/her own work, determines the sequence of assignments, selects and develops methods, and seeks assistance from experts only rarely. 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.

To apply for this position, you must submit the required documentation outlined under the REQUIRED DOCUMENTS section below.

The complete initial Application must be submitted by 11:59 PM (EST) on 05/19/2026. PLEASE

NOTE: If your materials are not received by the closing date, your application will be evaluated solely on the information available and you may not receive full consideration or may not be considered eligible. Also, if you do not provide a valid email address, you may not be notified of the outcome of your application. To begin the process, click the Apply Online button to create an account or log into your existing USAJOBS account.

Follow the prompts to complete the occupational questionnaire. Please ensure you click the Submit My Answers button at the end of the process.

Note: To check the status of your application or return to a previous or incomplete application, log into your USAJOBS account, select Application Status, and click on the more information link under the application status for this position. Applications and supporting documentation will not be accepted by mail or email. If you need further assistance, contact the Human Resources Office representative listed on this announcement at least one day prior to the closing date for further instructions.

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: U.

S. Public Health Service Officers Cover Letter/Letter of Interest. Degrees. (Place under "Diploma/GED") Professional license. (If applicable) Additional professional certificates. (If applicable) Three professional references. (i.e., name, title and contact information) 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. *Three most recent Commissioned Officer Effectiveness Reports (COER). (Place under "Performance Appraisal") A copy of your current Service Remaining Requirements Agreement. 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.