Nurse

For Nurse, GS-0610-12: Communicates and coordinates with health care providers to assess appropriate levels of home health care to ensure the care the claimant receives reflects the policies and procedures of DEEOIC.

Coordinates and conducts outreach and training to medical providers and other stakeholders, program staff, other Federal Agencies, and the general public.

Under the direction and leadership of the Lead Nurse and Unit Manager, the employee plans and implements assignments, projects, and/or studies in the areas of home health care, durable medical equipment, and other medical issues.

Utilizes current medical and scientific knowledge, medical journals, reference manuals, books, the DEEOIC Procedure Manual and related policy, and other resources to develop rationale for his/her opinions.

Provides input for accurate application of medical guidelines to the processing of medical services by serving as a resource for medical billing issues. The employee develops training materials for DEEOIC staff, health care providers, and beneficiaries.

Works with the Medical Bill Pay staff or other National Office staff to monitor procedures and evaluate their validity and cost-effectiveness by the utilization of models from Medicare and other federal agencies.

Within the assigned area, determines medical appropriateness of requested ancillary procedures and/or services that require authorization by senior management.

IN DESCRIBING YOUR EXPERIENCE PLEASE BE CLEAR AND SPECIFIC, PLEASE USE THIS FORMAT MM/DD/YYYY WHEN DATING YOUR EXPERIENCE. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR SPECIALIZED EXPERIENCE, DATES OF EMPLOYMENT OR SALARY. This position has an Individual Operation Requirement (IOR) that must be met.

You must meet all requirements at the time of your application. Basic Requirements: Note: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. Education - Transcripts must be submitted with your application package.

A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required.

This education must have been accredited by the Commission on Collegiate Nursing Education (external link), Council on Accreditation of Nurse Anesthesia Educational Programs (external link), Accreditation Commission for Midwifery Education (external link), or an accrediting body recognized by the U.S.

Department of Education (external link) at the time the degree was obtained. Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools (external link) is required for individuals who graduated from foreign nursing schools.

Licensure - A copy of your license must be submitted with your application package. If you have recently renewed your license, please submit renewal documentation. For all grade levels and positions, applicants must have passed the National Council Licensure Examination (external link).

In addition, they must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

Additional License Requirements for Advanced Practice Nurse Positions: Applicants for Advanced Practice Nurse positions must be licensed or registered by a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States in the clinical specialty required by the position. *** In addition to the mandatory license and education described above under Basic Requirements applicants must have at least one or more full years of professional nursing experience that is equivalent to the next lower grade level. *** Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-11 in the Federal Service.

Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled.

To be creditable, specialized experience must have been equivalent to at least the next lower grade level.

Qualifying specialized experience for GS-12 includes: Experience reviewing and evaluating complex medical evidence, including medical records, physician reports, treatment plans, and medical/scientific literature, to determine medical necessity or appropriateness of health-care services and prepare clinically supported assessments or recommendations.

Experience applying medical policies, health-care guidelines, and claims or medical-billing requirements to resolve medical issues associated with claims adjudication, authorization of medical services, home health care, durable medical equipment, or other health-care benefits.

Experience developing, analyzing, or evaluating medical policies, guidelines, standards, or procedures, including assessing their clinical validity, effectiveness, utilization or cost-effectiveness, and recommending or implementing program improvements.

Experience providing professional medical consultation and technical assistance to internal and external stakeholders, including coordinating with health-care providers, advising claims or program staff on complex medical matters, and developing or delivering medical-policy training and outreach.