Health System Specialist

Veterans Health Administration•Lakewood, CO

About The Position

This position is in the Civilian Health and Medical Program-VA (CHAMPVA), Veteran and Family Member Programs (VFMP) Directorate, Office of Integrated Veteran Care (IVC), Veterans Health Administration (VHA), Department of Veterans Affairs (VA), and is organizationally aligned under the Chief, CHAMPVA. Its primary function is to provide care coordination support for beneficiaries enrolled in CHAMPVA Programs. The Health System Specialist applies analytical and evaluative techniques to identify, consider, and resolve procedural or factual issues. The role plans and carries out fact-finding and analysis, recognizes when additional information is needed, and evaluates recommendations in light of resource constraints, staffing realities, and organizational dynamics. It also supports strategic alignment of care coordination programs with VHA strategic plans, VISN priorities, facility leadership objectives, and emerging national program emphases. The position assists case management providers and beneficiaries with claim-processing errors, delays, benefits, pre-authorizations, and other authorized services. It communicates with beneficiaries, providers, clinical chiefs, community partners, Veterans' families, and VISN program managers, including when interactions are difficult or adversarial. Outreach and updates may be provided by email, phone, teleconference, standard letters, social media, and other publicly accessible digital collaboration platforms. The specialist conducts phone interviews to assist with eligibility issues and healthcare services appropriate to beneficiary needs, and independently makes decisions about program structure, resource allocation, and priorities. The work schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Compressed or flexible scheduling is available. Ad hoc telework may be authorized. Virtual work may be authorized for current VA employees already subject to the return-to-in-person-work mandate in their current position; return-to-office mandates are in effect, and selectees must report in person unless an exception or exemption is approved. Relocation/recruitment incentives, critical skills incentive, and permanent change of station are not authorized.

Requirements

U.S. citizenship.
Meet applicable time-in-grade requirements for current or former federal employees applying at GS-09 or GS-11.
For GS-09, one year of specialized experience equivalent to at least GS-07, such as applying healthcare delivery system knowledge to guide beneficiaries and recommend program improvements, working with healthcare facilities to interpret requirements and gather technical information, or explaining VA policies and regulations to beneficiaries and providers; alternatively, qualifying related graduate education or a combination of education and experience.
For GS-11, one year of specialized experience equivalent to at least GS-09, such as conducting qualitative and quantitative program analyses, independently investigating complex issues and presenting recommendations, or reviewing and interpreting correspondence and technical documents to resolve customer and stakeholder concerns; alternatively, qualifying related doctoral-level graduate education or a combination of education and experience.
Complete the application, questionnaire, and required online assessment.
Complete background/security investigation and online onboarding requirements.
Participate in the VA seasonal influenza vaccination program.
Serve a one-year probationary period or two-year trial period, as applicable.
Report to in-person work unless approved for an applicable return-to-office exception or exemption.

Responsibilities

Apply analytical and evaluative techniques to identify and resolve procedural or factual issues.
Plan, coordinate, and carry out fact-finding and analysis for assigned projects; identify when additional information is needed.
Assess how proposed changes may be received by different audiences and adjust their framing, sequence, or content.
Build and sustain communication channels through social media and other publicly accessible digital collaboration platforms.
Evaluate recommendations against resource constraints, staffing realities, and political or organizational dynamics.
Assist local case management providers and beneficiaries with claim-processing errors, delays, benefits, pre-authorizations, and other authorized services.
De-escalate difficult customer interactions while maintaining professional credibility and working relationships.
Conduct beneficiary outreach by email, phone, teleconference, or standard letters.
Provide routine updates to providers and beneficiaries on available services and current policies, and communicate proactively when timelines, outputs, or circumstances change.
Conduct phone interviews with beneficiaries, healthcare providers, and authorized third-party contacts to assist with eligibility issues and healthcare services appropriate to beneficiary needs.
Make independent decisions about care coordination program structure, allocation of limited resources, and prioritization of program components.
Align care coordination programs with VHA strategic plans, VISN priorities, facility leadership objectives, and emerging national program emphases.
Identify program misalignment with emerging priorities and proactively propose realignment.