Health System Specialist

Job Title

Health System Specialist

Duties

The position requires skill in applying analytical and evaluative techniques to the identification, consideration, and resolution of issues or problems of a procedural or factual nature. Recognizes when available data is insufficient to support a conclusion and identifies what additional information is needed.

The employee plans, coordinates, and carries out the successive steps in fact-finding and analysis of issues necessary to complete each phase of assigned projects. Anticipates how a proposed change will be received by different audiences and adjusts the framing, sequencing, or content accordingly.

Builds and sustains comprehensive communication channels via social media and other publicly accessible digital collaboration platforms. Weighs the feasibility of recommendations against resource constraints, staffing realities, and political/organizational dynamics.

Assists local case management providers and beneficiaries to explain claim processing errors, delays or other problems regarding benefits, pre-authorizations for care and other authorized service activities. Regularly interacts with customers - clinical chiefs, community partners, Veterans' families, VISN program managers - who may be frustrated, skeptical, or adversarial. Effective customer service at this level means de-escalating tension, maintaining professional credibility, and preserving the working relationship even when the interaction is uncomfortable.

Facilitates outreach to beneficiaries via email, phone, teleconference or standard letters. Independently provides routine updates to providers and beneficiaries on available services and current policies. Communicates proactively when timelines, outputs, or circumstances change - does not wait for the customer to notice a problem.

Conducts phone interviews with program beneficiaries, health care providers and other authorized third-party contacts to assist with eligibility issues and healthcare services appropriate to beneficiary needs.

Must independently make decisions about how CHAMPVA care coordination programs are structured, how limited resources are allocated across competing program needs, and which program components to prioritize when everything cannot be done simultaneously.

Distinguishes between stakeholder input that should change the decision and stakeholder pressure that should not.

Must ensure that care coordination programs are not just operationally sound but strategically positioned - aligned with VHA's strategic plan, VISN priorities, facility leadership objectives, and emerging national program emphases.

Identifies where current care coordination programs are misaligned with emerging organizational priorities and proactively proposes realignment before leadership identifies the gap.

Work Schedule

Monday through Friday 8:00am to 4:30 pm Compressed/Flexible: Available

Telework

This position may be authorized for ad hoc telework. Telework eligibility will be discussed during the interview process. Ad hoc is defined as occasional, non-recurring telework Virtual: This position may be authorized for Virtual Work. Virtual Work eligibility is for current VA employees that are already subject to the return to the in-person work mandate in their current position. Definition of Virtual Work: Employee works outside of original hiring duty station at a VA-owned or leased space. Return to Office (RTO): RTO mandates are in effect and selectees will be required to report to in-person work unless they are approved for an exception or an exemption. Any approval for an RTO exception, exemption, or extension will happen after a tentative job offer, but before a final job offer.

Position Description/PD#: Health System Specialist/

PD68675A and PD68674A

Relocation/Recruitment Incentives

Not Authorized

Critical Skills Incentive (CSI):

Not Approved

Permanent Change of Station (PCS):

Not Authorized