remanded H-1B Case: Healthcare

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U.S. Department of Homeland Security 
20 Mass. Ave., N.W., Rrn. A3042 
Washington, DC 20529 
U. S. Citizenship 
and Immigration 
FILE: WAC 04 221 54362 Office: CALIFORNIA SERVICE CENTER ~ateApR 2 6 2006 
PETITION: Petition for a Nonimmigrant Worker Pursuant to Section 101 (a)(l 5)(H)(i)(b) of the 
Immigration and Nationality Act, 8 U.S.C. 1 10 1 (a)(l 5)(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 mher inquiry must be made to that office. 
Robert P. Wiemann, Director 
Administrative Appeals Office 
WAC 04 221 54362 
Page 2 
DISCUSSION: The service center director denied the nonimmigrant visa petition and the matter is now 
before the Administrative Appeals Office (AAO) on appeal. The director's decision shall be withdrawn and 
the petition remanded for entry of a new decision. 
The petitioner is an outpatient clinic and provider of physical, occupational, and speech therapy. It seeks to 
employ the beneficiary as a medical research assistant. The petitioner endeavors to classify the beneficiary as a 
nonimmigrant worker in a specialty occupation pursuant to section lOl(a)(l5)(H)(i)(b) of the Immigration and 
Nationality Act (the Act), 8 U.S.C. § 1 101 (a)(lS)(H)(i)(b). 
The director denied the petition because the proffered position does not qualify as a specialty occupation. On 
appeal, counsel submits a brief stating that the offered position qualifies as a specialty occupation. 
The issue to be discussed in this proceeding is whether the proffered position qualifies as a specialty 
occupation. 
Section 10 1 (a)(l S)(H)(i)(b) of the Act, 8 U.S.C. 5 1 10 1 (a)(l 5)(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. 8 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. 
The term "specialty occupation" is further defined at 8 C.F.R. Ej 214.2(h)(4)(ii) as: 
[A]n occupation which requires theoretical and practical application of a body of highly 
specialized knowledge in fields of human endeavor including, but not limited to, architecture, 
engineering, mathematics, physical sciences, social sciences, medicine and health, education, 
business specialties, accounting, law, theology, and the arts, and which requires the attainment of 
a bachelor's degree or higher in a specific specialty, or its equivalent, as a minimum for entry 
into the occupation in the United States. 
Pursuant to 8 C.F.R. 9 214.2(h)(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; 
WAC 04 221 54362 
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(3) The employer normally requires a degree or its equivalent for the position; or 
(4) The nature of the specific duties are so specialized and complex that knowledge required 
to perform the duties is usually associated with the attainment of a baccalaureate or 
higher degree. 
Citizenship and Immigration Services (CIS) interprets the term "degree" in the criteria at 8 C.F.R. 
3 2 14.2(h)(4)(iii)(A) to mean not just any baccalaureate or higher degree, but one in a specific specialty that is 
directly related to the proffered position. 
The record of proceeding before the AAO contains: (1) the Form 1-129 and supporting documentation; 
(2) the director's request for additional evidence; (3) the petitioner's response to the director's request; (4) 
the director's denial letter; and (5) the Form I-290B with supporting documentation. The AAO reviewed the 
record in its entirety before issuing its decision. 
The petitioner is seeking the beneficiary's services as a medical research assistant. Evidence of the 
beneficiary's duties was included with the Form 1-129 petition and in response to the director's request for 
evidence. According to this evidence the beneficiary would: 
Review major professional medical journals for health issues and developments that are particularly 
relevant to patients and clients - Based on research the beneficiary will help interpret and implement 
quality assurance standards in the clinic to ensure quality care by coordinating activities of clinical, 
clerical, and the rest of the rehabilitative personnel. The beneficiary will also establish work 
schedules and assignments for the health care staff and assist in the coordination of quality assurance 
for health agency contracts; 
Review medical records and patient profiles, and discuss those profiles, deficiencies and 
inconsistencies with supervising clinicians - Review quality assurance standards, scrutinize existing 
policies and procedures, and interview clinical staff to evaluate the effectiveness of the quality 
assurance program in order to identify problem areas and recommend remedial action; 
Research medical literature to find suggestions of modes of treatment or possible diagnoses for 
unusual cases, develop treatment procedures for medical application, and recommend test methods to 
referring physicians based on research that generate the most effective treatment approach for a 
specific diagnosis or condition - Develop and expand rehabilitative care programs and services for 
research, rehabilitation, and holistic health promotion by keeping abreast of technological advances in 
rehabilitative care machination, and represent the petitioner in conferences, trainings, seminars, 
forums pertaining to medical research, quality assurance, health management and related issues; 
Suggest to affiliated clinicians test methods for diagnosis or medical procedures for treatment 
approaches for specific diagnoses or conditions based on research studies - Contribute to a team 
effort to ensure that rehabilitative care innovations are given to patients, and document apparent 
WAC 04 221 54362 
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disease patterns to assist physicians in devising treatment regimens consistent with studies and 
research conducted; 
Analyze data, prepare reports and present findings for possible application to healthcare provider 
programs, and present study results to physicians, the community, and insurance carriers to justify 
treatment methods - Develop and expand rehabilitation programs and services, and review and 
inspect facilities for emergency readiness and regulation compliance recommending structure or 
equipment modification; 
Plan design of research studies and data collection, and recommend criteria for quality assurance and 
treatment protocols - Develop organizational policies and procedures and establish criteria for the 
outpatient rehabilitation clinic, and coordinate care plans, clinical notes and other rehabilitation 
services notes to ensure that patient evaluations, clinical goals, treatment, patient response, and 
recommended course of treatment at discharge are reflected on patient discharge summaries; and 
Supervise the activities of clinical, statistical, clerical and other medical research personnel - 
Participate in the recruitment, hiring and performance appraisals of healthcare personnellstaff. 
The petitioner requires a minimum of a bachelor's degree in a medical field for entry into the proffered 
position. 
CIS often looks to the Department of Labor's Occupational Outlook Handbook (Handbook) when 
determining whether a baccalaureate or higher degree or its equivalent is normally the minimum requirement 
for entry into a particular position. The petitioner and the director conclude that the duties of the offered 
position are those of a medical research assistant as listed under "medical writerlresearcher" in the Handbook. 
The AAO does not agree. The referenced section of the Handbook notes that medical writers prepare a range 
of formal documents presenting detailed information on the physical and biological sciences. They convey 
research findings to the scientific and medical professions. Many work with researchers on technical subjects 
to prepare written interpretations of data and other information for a general readership. The duties to be 
performed by the beneficiary are neither those of a medical writer, or a medical research assistant. The 
petitioner noted in its letter of September 13, 2004, that the offered position is based on the demands of its 
insurance carriers and contracts. The petitioner expresses a need for an employee to be able to understand 
medical terminology and written documentation, gather and collate medical data, and compare it with existing 
norms. The beneficiary would then collect and analyze data using statistical formulas, and present that data to 
medical facilities, physicians, insurance carriers and other contracting parties to improve care quality and 
provide justification for services provided, including the frequency of intervention. This would require 
monitoring and tracking of staff documentation and patient outcomes to ensure that they fall within standard 
norms for patient diagnosis and conditions. The beneficiary would assist the Quality Assurance (QA) 
manager in providing quality assurance to verify completeness of reports to determine appropriate treatment 
methods and the frequency of treatment. The petitioner notes that insurance camers and HMO contracts 
provide clients but want a statistical history to justify clinical pathways for diagnosis and payment. The 
petitioner states that many of the duties to be performed are essentially those of a quality assurance assistant 
with additional managerial responsibilities. 
WAC 04 221 54362 
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In addition to the above mentioned responsibilities, the beneficiary would also research medical literature to 
find suggestions of modes of treatment or possible diagnoses for unusual cases, develop treatment procedures 
for medical application, and recommend test methods to referring physicians based on research that generates 
the most effective treatment approach for a specific diagnosis or condition. She would suggest to clinicians 
test methods for diagnosis or medical procedures for treatment approaches for specific diagnoses or 
conditions based on research studies. These are duties similar to those typically performed by physician's 
assistants (PA). The Handbook describes a PA as follows: "working as members of the health care team, 
they take medical histories, examine and treat patients, order and interpret laboratory tests and x rays, and 
make diagnoses," According to the Handbook, all states require that PA's complete an accredited, formal 
education program and pass a national exam to obtain a license. Based on the Handbook's information and 
submitted evidence, the AAO finds that the proffered position qualifies as a specialty occupation in that the 
duties of the position are so specialized and complex that knowledge required to perform the duties is usually 
associated with a baccalaureate or higher degree. 8 C.F.R. § 214.2(h)(4)(iii)(A)(4). 
The final issue to be determined is whether the beneficiary is qualified to perform the duties of the offered 
specialty occupation. As noted in the Handbook PA's provide healthcare services under the supervision of 
physicians and must be licensed. This matter will be remanded to the director to determine if the beneficiary, 
who would be employed in an outpatient clinic that provides physical, occupational, and speech therapy, 
would work under the supervision of a physician and whether she is appropriately licensed to work as a PA. 
The record does not establish that the petitioner has a medical doctor on staff. It is noted, however, that the 
beneficiary would work with referring physicians in the treatment of patients and diagnosis of medical 
conditions. The director must afford the petitioner reasonable time to provide evidence pertinent to these 
issues, and may request such additional evidence as he deems appropriate in rendering his decision. 
As always, the burden of proof in these proceedings rests solely with the petitioner. Section 291 of the Act, 
8 U.S.C. 9 1361. 
ORDER: The director's decision is withdrawn. The petition is remanded to the director to enter a new 
decision commensurate with the directives of this opinion. The director shall certify the matter to 
the AAO should his determination be adverse to the petitioner.