Nurse Consultant

Duties
As Nurse Consultant you will:

• Review weekly request from physicians requesting beneficiary's condition be "authorized" for treatment within the program.
• Review and make decisions on requests using clinical expertise.
• Responsible for medical necessity review of treatment requests.
• Assist medical director in developing medical policy for treatment authorization.
• Review or consult on provider treatment claims and appropriateness of payments.

Qualifications
BASIC REQUIREMENT:
Education: Degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed by the applicant.
Registration: Applicants must have active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
Applicant who has graduated from an approved nursing educational program within the past 12 months may be appointed pending State registration as a professional nurse within 6 months of appointment. No person appointed pending registration may be retained beyond 6 months, or promoted, if registration has not been attained.

REGISTRATION:
Applicants must have active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. An applicant who has graduated from an approved nursing educational program within the past 12 months may be appointed pending State registration as a professional nurse within 6 months of appointment. No person appointed pending registration may be retained beyond 6 months, or promoted, if registration has not been attained.

MINIMUM REQUIREMENT:
GS-12 Applicants must have at least one year of specialized experience at or equivalent to the GS-11 in the Federal service as defined in the next paragraph.

Specialized experience is experience which is directly related to the position which has equipped the applicant with the particular knowledge, skills and abilities (KSAs) to successfully perform the duties of the position to include experience in managing complex program deliverables and collaborating with occupational health subject matter experts.

GS-13 Applicants must have at least one year of specialized experience at or equivalent to the GS-12 in the Federal service as defined in the next paragraph.

Specialized experience is experience which is directly related to the position which has equipped the applicant with the particular knowledge, skills and abilities (KSAs) to successfully perform the duties of the position to include experience in providing health care service delivery and program administration to serve as a certification specialist in the certification unit for medical and pharmaceutical benefits team.

Education
Foreign Education: Education completed in colleges or universities outside the United States may be used to meet the education requirements. You must provide acceptable documentation that the foreign education is comparable to that received in an accredited educational institution in the United States.

Conditions of Employment:

1. Security and Background Requirements: If not previously completed, a background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
2. E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.
3. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.