dismissed H-1B Case: Healthcare

PUBLIC COW 
U.S. Department of Homeland Security 
20 Mass. Ave., N.W., Rm. 3000 
Washington, DC 20529 
U. S. Citizenship 
and Immigration 
FILE: WAC 04 227 50358 Office: CALIFORNIA SERVICE CENTER Date: UG 2 5 2006 
PETITION: Petition for a Nonimrnigrant Worker Pursuant to Section 10 1 (a)(l 5)(H)(i)(b) of the 
Immigration and Nationality Act, 8 U.S.C. 9 1 lOl(a)(lS)(H)(i)(b) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
This is the decision of the Administrative Appeals Office in your case. All documents have been returned to 
the office that originally decided your case. Any further inquiry must be made to that office. 
bdministrative &peals Office 
WAC 04 227 50358 
Page 2 
DISCUSSION: The Director, California Service Center, denied the nonimmigrant visa petition and the 
matter is now before the Administrative Appeals Office (AAO) on appeal. The appeal will be dismissed. The 
petition will be denied. 
The petitioner is a 99-bed skilled nursing facility. It seeks to employ the beneficiary as a patient care 
coordinator. Accordingly, the petitioner endeavors to classify the beneficiary as a nonimrnigrant worker in a 
specialty occupation pursuant to section lOl(a)(lS)(H)(i)(b) of the Immigration and Nationality Act (the Act), 
8 U.S.C. 8 1 lOl(a)(lS)(H)(i)(b). 
On October 29, 2004, the director denied the petition determining that the record did not establish that the 
proffered position is a specialty occupation. On appeal, counsel for the petitioner submits a brief and 
re-submits the same documentation submitted with the Form 1-129. 
Section lOl(a)(lS)(H)(i)(b) of the Act, 8 U.S.C. 8 1 lOl(a)(lS)(H)(i)(b), provides, in part, for the 
classification of qualified nonimmigrant aliens who are coming temporarily to the United States to perform 
services in a specialty occupation. 
Section 214(i)(l) of the Act, 8 U.S.C. 5 1184(i)(l), defines the term "specialty occupation" as an occupation 
that requires: 
(A) theoretical and practical application of a body of highly specialized knowledge, and 
(B) attainment of a bachelor's or higher degree in the specific specialty (or its equivalent) 
as a minimum for entry into the occupation in the United States. 
Pursuant to 8 C.F.R. 5 214.2@)(4)(iii)(A), to qualify as a specialty occupation, the position must meet one of the 
following criteria: 
(I) A baccalaureate or higher degree or its equivalent is normally the minimum requirement 
for entry into the particular position; 
(2) The degree requirement is common to the industry in parallel positions among similar 
organizations or, in the alternative, an employer may show that its particular position is 
so complex or unique that it can be performed only by an individual with a degree; 
(3) The employer normally requires a degree or its equivalent for the position; or 
(4) The nature of the specific duties is so specialized and complex that knowledge required 
to perform the duties is usually associated with the attainment of a baccalaureate or 
higher degree. 
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Citizenship and Immigration Services (CIS) interprets the term "degree" in the criteria at 8 C.F.R. 
6 214.2(h)(4)(iii)(A) to mean not just any baccalaureate or higher de'gree, but one in a specific specialty that is 
directly related to the proffered position. 
When determining whether a particular job qualifies as a specialty occupation, CIS does not only rely on a 
position's title. The specific duties of the proffered position, combined with the nature of the petitioning 
entity's business operations, are factors to be considered. CIS must examine the ultimate employment of the 
alien, and determine whether the position qualifies as a specialty occupation. C$ Defensor v. Meissner, 201 
F. 3d 384 (5fi Cir. 2000). The critical element is not the title of the position nor an employer's self-imposed 
standards, but whether the position actually requires the theoretical and practical application of a body of 
highly specialized knowledge, and the attainment of a baccalaureate or higher degree in the specific specialty 
as the minimum for entry into the occupation, as required by the Act. 
The record of proceeding before the AAO contains: (1) the Form 1-129 and supporting documentation; (2) 
the director's October 29, 2004 denial letter; and (3) the Form I-290B and the petitioner's November 23, 2004 
letter in support of the appeal. The AAO reviewed the record in its entirety before issuing its decision. 
The petitioner is seeking the beneficiary's services as a patient care coordinator. According to the petitioner's 
June 8,2004 letter appended to the Form 1-129, the beneficiary's position as a patient care coordinator would 
include: 
[A] systematic nursing work planning, [sic] review and coordination of pertinent services 
related to medical, nursing, therapy, and rehabilitative care; likewise the Patient Care 
[Cloordinator is tasked to coordinate the development of a comprehensive individual patient 
care plans [sic] to meet the specific needs of residents of the health care center. In addition, 
the Patient Care Coordinator will provide liaison work with other departments, disciplines, or 
offices within the organization in the development and delivery of patient care services. 
The petitioner provided a copy of its job notice for the position with the above described duties and indicated 
that it needed "a degree holder preferably in the area of health care, health care management or related 
disciplines in medical-paramedical services." The petitioner provided copies of several job announcements 
and lists of job openings for the position of patient care coordinator, and one for patient care coordinator, 
emergency nursing care of children. The job announcements indicated the organizations seeking coordinators 
required an R.N (registered nurse) degree, a bachelor of science in nursing for the position of patient care 
coordinator, emergency nurse care of children, or a bachelor's degree in unspecified disciplines or in a 
medically related or public relations field. 
The director found that the proffered position was not a specialty occupation because the petitioner failed to 
establish any of the criteria found at 8 C.F.R. 5 214.2@)(4)(iii)(A). The director observed that the position of 
patient care coordinator most closely resembled the position of a registered nurse. The director further 
observed that the proffered position included characteristics beyond that of an entry-level registered nurse but 
was not analogous to an administrative nursing position. The director, relying on a Memorandum by Johnny 
N. Williams, Executive Associate Commissioner, INS Office of Field Operations, Guidance on Adjudication 
WAC 04 227 50358 
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of H-IB Petitions Filed on Behalf of Nurses, HQISD 7016.2.8-P (November 27, 2002) (Williams' 
memorandum), acknowledged that there were an increasing number of nursing specialties that required a 
higher degree of knowledge and skill than a typical R.N. or staff nurse position. The director noted that the 
Williams' memorandum mentioned that a number of certification examinations were available to registered 
nurses who work in such nursing specialties but who are not advanced practice nurses. The director 
concluded, based on the record, that the petitioner had not provided evidence regarding parallel positions in 
the petitioner's industry or from professional associations regarding an industry standard or documentation to 
support the complexity or uniqueness of the proffered position or that the nature of the specific duties of the 
position is so specialized and complex that the position requires knowledge usually associated with the 
attainment of a baccalaureate or higher degree. 
On appeal, the petitioner claims that the job sites consulted and provided in support of the petition indicated 
the necessity of a baccalaureate degree for the position of a patient care coordinator. The petitioner asserts 
that the proffered position straddles the requirements of fundamental knowledge of health care delivery and 
the administration of health care services. The petitioner contends that the position of patient care coordinator 
requires a specialized understanding of the "nursing profession" but also the broader framework of patient 
care and the technical dexterity to manage the delivery of patient care. The petitioner notes that while the 
beneficiary is a registered nurse she will be performing duties that require a specialized skill in patient care 
and the management of health care service and delivery, including management of care settings and 
overseeing of activities, duties associated with a position of medical and health services manager. The 
petitioner also references the previously submitted job announcements and its job notice as evidence that an 
applicant must be a degree holder, preferably in the area of health care, health care management, or related 
disciplines in the medical-paramedical services. The petitioner concludes by indicating that it requires a 
bachelor's degree, such a degree is a common requirement in the industry, and the nature of the duties are 
specialized and complex, requiring the services of an applicant that is degreed, trained, and experienced in 
relevant health care areas. 
The petitioner's argument and evidence is not persuasive. The petitioner has not established that the proffered 
position fulfills any of the four criteria outlined in 8 C.F.R. 5 214.2(h)(4)(iii)(A). Therefore, the proffered 
position is not a specialty occupation. 
The AAO first considers whether the petitioner has established that the petitioner has fulfilled either of the 
criteria at 8 C.F.R. $5 214.2(h)(4)(iii)(A)(l) or (2): a baccalaureate or higher degree or its equivalent is the 
normal minimum requirement for entry into the particular position; a degree requirement is common to the 
industry in parallel positions among similar organizations; or a particular position is so complex or unique 
that it can be performed only by an individual with a degree. Factors often considered by CIS when 
determining these criteria include: whether the Handbook reports that the industry requires a degree; whether the 
industry's professional association has made a degree a minimum entry requirement; and whether letters or 
affidavits from firms or individuals in the industry attest that such firms "routinely employ and recruit only 
degreed individuals." See Shanti, Inc. v. Reno, 36 F. Supp. 2d 1 15 1, 1 165 (D.Minn. 1999)(quoting HirdIBlaker 
Corp. v. Suva, 712 F. Supp. 1095, I 102 (S.D.N.Y. 1989)). 
WAC 04 227 50358 
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In this matter, the AAO finds that the description of the duties of the proffered position corresponds to the 
duties of a registered nurse. The petitioner also recognizes that a patient care coordinator is a registered nurse 
position but asserts that a patient care coordinator includes some duties relevant to a position of medical and 
health services manager. The Handbook does not describe the specific proffered occupation of patient care 
coordinator. In this instance however, the petitioner requires that the incumbent conduct patient care, 
participate in the discussion relative to the assessment of patient's needs and problems, meet with nurses and 
support staff and maintain minutes of the meetings, document patient care plans, conduct utilization review 
for patients, compile data from medical records to assess patients' requirements and level of care, make 
rounds with medical staff, identify and recommend solutions to problems relevant to patient care services, 
write up reports, coordinate and/or make patient care visits, coordinate admissions and assessment, coordinate 
and/or conduct initial assessment of patient, and coordinate the teaching of patientlcaregiver techniques, 
activities associated with a registered nurse position. 
The AAO acknowledges that the petitioner is a 99-bed skilled nursing facility and that the Handbook reports: 
"[iln smaller facilities, top administrators handle more of the details of daily operations. For example, many 
nursing home administrators manage personnel, finances, facility operations, and admissions and also have a 
larger role in resident care." Upon review of the petitioner's description of the proffered position's duties, the 
duties are not sufficiently defined to determine that the petitioner's successful incumbent will manage 
personnel, finances, facility operations, but rather will primarily be involved in patient care including duties, 
such as assembling patients' health information and communicating with other health care professionals to 
clarify diagnoses or to obtain additional information, duties that correspond to the duties of a health 
information technician, not a health services manager. The Handbook reports that a registered nurse may 
obtain an associate degree or diploma to enter into the nursing field and that a health information technician 
also may obtain an associate degree to enter into the field. The Handbook does not indicate that either a 
registered nurse or a health information technician are required to attain a bachelor's degree or higher degree 
or its equivalent as the normal minimum requirement for entry into the particular position. The petitioner has 
not provided sufficient evidence to establish that the position satisfies the criterion at 8 C.F.R. 
5 2 14,2(h)(4)(iii)(A)(I). 
The petitioner has not presented evidence that any professional association within its industry has made a 
degree a minimum entry requirement into a patient care coordinator position. Going on record without 
supporting documentary evidence is not sufficient for purposes of meeting the burden of proof in these 
proceedings. Matter of Sofjci, 22 I&N Dec. 158, 165 (Comm. 1998) (citing Matter of Treasure Craft of 
California, 14 I&N Dec. 190 (Reg. Comm. 1972)). Neither has the petitioner presented letters or affidavits 
from firms or individuals in the industry attesting that such firms "routinely employ and recruit only degreed 
individuals." 
The evidence before both the director and the AAO consists of the petitioner's letter in support of the petition 
and job announcements from other care facilities and websites advertising for a patient care coordinator 
position. Regarding the job announcements, the AAO observes that one job announcement indicates that a 
registered nurse degree is required, but that a bachelor of science in nursing is preferred. A second job 
announcement is for a patient care coordinator, emergency nursing care of children, a position that connotes a 
higher complexity of training because of the emergency nature of the position as well as the position's 
WAC 04 227 50358 
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involvement with children. This position requires that the successful candidate have a bachelor of science 
degree in nursing. Two announcements indicate that the advertised position requires a bachelor's degree in a 
medically-related or public relations field and two years of experience as a patient care coordinator. Finally, 
the petitioner submits a list of employers seeking patient care coordinators that indicates generally a 
bachelor's degree is the educational level sought; although the employers do not specify that the bachelor's 
degree be in a specific discipline. The record does not contain sufficient evidence to demonstrate that the 
organizations in the job announcements "routinely employ and recruit only degreed individuals." 
In addition, the job announcements do not include detailed descriptions of the type or size of the listing 
organizations. The AAO notes that the organizations hiring for a patient care coordinator include two 
hospitals, a hospice facility, and a preventive medicine clinic. The hospice facility, the organization that most 
closely resembles the petitioner's facility, requires only that its patient care coordinator be a registered nurse 
and the job listing does not indicate the size of the facility or the number of its employees. As such, the 
record does not contain information that organizations similar to the petitioner "routinely employ and recruit 
only degreed individuals" for positions parallel to the petitioner's proffered position. Accordingly the 
petitioner has not established that the degree requirement is common to the industry in parallel positions among 
similar organizations. 
In the alternative, the petitioner may show that the proffered position is so complex or unique that only an 
individual with a degree can perform the work associated with the position. In the instant petition, the 
petitioner does not claim and does not submit documentation demonstrating that the proffered position is 
either so unique or complex that it would require an individual with a degree in a specific specialty. The 
evidence of record fails to establish that the proffered position is a specialty occupation under either prong of 
the criterion at 8 C.F.R. 214.2(h)(4)(iii)(A)(2). 
The third criterion at 8 C.F.R. tj 214.2(h)(4)(iii)(A) requires that the petitioner establish that it normally requires a 
degree or its equivalent for the position. The petitioner's desire to employ an individual with a bachelor's 
degree in the area of health care, health care management, or related disciplines in medical-paramedical 
services does not establish that the position is a specialty occupation. CIS must examine the ultimate 
employment of the alien, and determine whether the position qualifies as a specialty occupation. C.' Defensor 
v. Meissner, 201 F. 3d at 384. The critical element is not the title of the position or an employer's 
self-imposed standards, but whether the position actually requires the theoretical and practical application of a 
body of highly specialized knowledge, and the attainment of a baccalaureate or higher degree in the specific 
specialty as the minimum for entry into the occupation as required by the Act. To interpret the regulations 
any other way would lead to absurd results. If CIS were limited to reviewing a petitioner's self-imposed 
employment requirements, then any alien with a bachelor's degree could be brought into the United States to 
perform a non-professional or non-specialty occupation, so long as the employer required all such employees 
to have baccalaureate degrees or higher degrees. See id. at 388. In addition, the petitioner does not specify 
that the successful candidate for this position will have a degree in a particular discipline; thus the petitioner 
fails to convey that the position warrants an individual trained and degreed in a specific discipline. Neither 
does the petitioner provide evidence that it has only hired individuals with a bachelor's degree or higher in a 
specific discipline when filling the position of patient care coordinator in the past. The petitioner has failed to 
persuade that it has satisfied the criteria at 8 C.F.R. 5 214.2(h)(4)(iii)(A)(3). 
WAC 04 227 50358 
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The evidence in the record is also inadequate to establish that the nature of the specific duties is so specialized 
and complex that the knowledge required to perform the duties is usually associated with the attainment of a 
baccalaureate or higher degree. 8 C.F.R. 5 214.2(h)(4)(iii)(A)(4). Again, the AAO observes that the 
petitioner and other organizations indicate that the employee in the position of patient care coordinator may 
have training and education in a variety of disciplines. Soliciting an individual with a broadly-based 
education undermines the petitioner's contention that the nature of a patient care coordinator's duties is 
specialized and complex. CIS looks beyond the title of the position and determines, from a review of the 
duties of the position and any supporting evidence, whether the position actually requires the theoretical and 
practical application of a body of highly specialized knowledge, and the attainment of a baccalaureate degree 
in a specific specialty as the minimum for entry into the occupation as required by the Act. The AAO is not 
persuaded that the nature of the specific duties of the proposed position is more specialized and complex than 
that of a registered nurse or technician nor, according to the Handbook, is the knowledge required to perform 
the duties of a registered nurse or health services technician usually associated with the attainment of a 
bachelor's or higher degree in nursing. Upon review of the totality of the record, the petitioner has not 
established that this position fulfills the criteria of 8 C.F.R. § 214.2(h)(4)(iii)(A)(4). 
The burden of proof in these proceedings rests solely with the petitioner. Section 291 of the Act, 8 U.S.C. § 1361. 
The petitioner has not sustained that burden. 
ORDER: The appeal is dismissed. The petition is denied.