The Northern Arizona VA Health Care System is currently recruiting for one Program Specialist in the Community Care Service, Prescott, Arizona. The incumbent conducts reviews in the areas of community care coordination and payment of claims related to care in the community with the Budget Analyst to attempt and resolve concerns from Veterans and community providers
The incumbent conducts reviews as required by their direct supervisor and medical center leadership. Other duties include, but are not limited to, the following: Contact members of the hospital staff at all levels concerning patient care issues not been resolved by other services and seeks resolution utilizing the full resources of the medical center and VA system. Explore all avenues, crossing lines of authority and responsibility within the medical center, to identify the nature and scope of the problem and to initiate appropriate action for resolution. Independently resolves the most difficult, complex, and sensitive care issues and system-related problems, applying advanced judgement across multiple program areas and organizational levels. Gather, analyze, and prepares information using sound judgement in response to inquiries, including Congressional Offices, White House Hotlines, Advance Credit Reports (ACR), VAIQs, Exec VA, CBI Helpline, Call Center Portals, and Reports of Contact while managing relationships across business units. Reviews files and records, and discusses with personnel or witnesses regarding any practice that appears to violate patient's rights or which causes unnecessary discomfort or embarrassment to patients, their families, or the health care facility and reports such findings with recommendations for improvements to the facility Director and/or top management team. Ensure national VA patient advocacy program requirements are met by collecting, analyzing, and evaluating relevant data, and preparing meaningful reports based on that data. - Evaluates the effectiveness, efficiency, and compliance of Community Care operations and related processes, and develops data-driven recommendations for improvement. Applies analytical and evaluative methods to assess program performance, identify trends, and recommend enhancements to improve service delivery and patient outcomes. Serve as an advocate for patients throughout Community Care Service, receiving and addressing complaints and grievances from patients or their representatives. Provides explanation regarding Veteran eligibility/entitlement to benefits according to the Veterans' Benefit Package and the laws and regulations governing VA authority to authorize payment for care in the community. Communicate with the Veteran to assist in filing claims and explain what action is needed by the Veteran to support their claims. Receives telephone calls regarding denied or rejected claims and coordinates with appropriate personnel when additional information is required for further review. Provides consultative guidance to leadership, staff, and stakeholders regarding patient advocacy issues, program operations, and regulatory requirements. Interprets and applies Federal laws, VA regulations, policies, and procedures to ensure compliance with the Mission Act and other governing authorities. Coordinates and reroutes calls appropriately with multiples departments are involved. Facilitates and follows through to ensure final resolution to the customer. Performs all other duties as assigned. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday through Friday, 8:00am to 4:30pm (Tour may be subject to change based on needs of the facility). Telework: Not Authorized Virtual: This is not a virtual position. Compressed/Flexible: Not Authorized Position Description/PD#: Program Specialist/PD132990 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required 30 Day Hiring Model The Department of Veterans Affairs is implementing a streamlined 30-Day Hiring Model designed to accelerate hiring while maintaining the highest standards of merit-based selection. This improved process reduces traditional hiring timelines by integrating early coordination, faster assessments, and efficient pre-employment actions. Applicants can expect a more transparent, predictable, and efficient hiring journey from announcement to entry on duty. What Applicants Can Expect: Expedited Candidate Review Once the announcement closes, Human Resources will quickly review applications, issue certificates of eligible candidates the day after the announcement closes and refer applicants for hiring manager consideration.
A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
roxana.green@va.gov 407-748-0540
Source: USAJOBS.gov — U.S. Federal Government
Apply on official site →