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

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.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: Incumbent must possess a minimum of three years of professional experience relevant to the officer's category. Of the total professional experience, at least one year of experience must be 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 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 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 current status. The agency may require the incumbent perform clinical activities within the scope of their 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. Must be able to develop knowledge and skills in the areas of utilization management (and/or case management) and medical necessity. Has knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery.

Currently has or can achieve and maintain utilization management or other applicable certification as directed by IHSC through formal training and other means. 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. Has a 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 Regional Utilization Manager (RUM). This is a non-supervisory position.

The HPMU Utilization Management Program (UMP) is a national level program and is 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, and clinical review outcomes, maintains records per program policy, chairs meetings, coordinates and manages programs within immediate organizational component.

UMP communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. IHSC has a multi-sector, multidisciplinary workforce of more than 1600 employees, including U.S. Public Health Service (PHS) commissioned officers, federal civil servants, and contract staff.

IHSC provides on-site direct patient care to ICE detainees at 17 detention facilities throughout the country and manages the provision of off-site medical care for detainees housed in approximately 230 authorized non-IHSC-staffed facilities, with a combined population of ~60,000 detainees daily, with an average length of stay of ~ 50 days, and over 400,000 detainees transitioning through these facilities annually. IHSC also provides medical support during ICE enforcement operations in the air, on the ground and at sea. SUPERVISORY CONTROLS: The URC reports directly to the assigned IHSC Regional Utilization Manager (RUM) with the Utilization Management Program Administrator (UMPA) as the reviewing official.

This is a non-supervisory position. The Officer is responsible for performing highly specialized professional duties related to Utilization Management and Utilization Review. Assignments are usually of a long-term, recurring or broadly defined nature.

Officer plans, and organizes own work, determines sequence of assignments, selects and develops methods and seeks assistance from experts only rarely. 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.

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 04/14/2026. 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. A copy of your Certificate of Investigation (located in your eOPF). *Three most recent Commissioned Officer Effectiveness Reports (COER). (Place under "Performance Appraisal") For IHSC USPHS officers only, 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. New Call to Active Duty Cover letter/Letter of Interest. Please include location preference here.

Degrees. (Place under "Diploma/GED") Professional license. (If applicable) Additional professional certificates. (If applicable) Three professional references (i.e., name, title, and contact information) CV - e.g., relevant experience, education, training. (Place under "USPHS Promotion CV") U.S. Public Health Service - Appointment Board Decision Letter/Email or a screenshot of AES dashboard to the United States Public Health Service