Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, (CPI), Fraud Investigations Group.
As a Health Insurance Specialist, GS-0107-12, you will develop policies and initiatives regarding program integrity in Medicaid managed care.
Duties
- Serves as a Health Insurance Specialist in the development, implementation, and evaluation of federal policies, guidance, and oversight initiatives regarding program integrity in Medicaid managed care.
- Analyzes, develops, implements, and modifies operating policy and procedures relating to program integrity in Medicaid managed care.
- Establishes rapport with partnering CMS components, as well as internal and external stakeholders to the organization on issues of a sensitive or critical nature to address evolving Medicaid managed care program issues.
- Prepares a variety of written products, including position papers and briefing materials for senior officials to use as background information on program integrity related activities.
Requirements
Conditions of Employment
- You must be a U.S. Citizen or National to apply for this position.
- You will be subject to a background and suitability investigation.
- You may be required to serve a 1 year probationary period.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.
In order to qualify for the GS-12 grade level, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include:
- Assist in developing, drafting and implementing policies, guidance, and oversight initiatives regarding program integrity in Medicaid managed care.
- Evaluate and assist in developing regulations and sub regulatory guidance, training, and technical assistance for state Medicaid agencies regarding high-risk areas of Medicaid managed care policies and processes.
- Establish and maintain working relationships with partnering organizations, as well as internal and external stakeholders to the organization on issues of a sensitive or critical nature to address evolving Medicaid managed care program issues.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Click the following link to view the occupational questionnaire:
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:
- Best Qualified - for those who are superior in the evaluation criteria
- Well Qualified - for those who excel in the evaluation criteria
- Qualified - for those who only meet the minimum qualification requirements
Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.
Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):
- Analysis
- Health Insurance
- Oral Communication
- Written Communication
This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.
Required Documents
The following documents are REQUIRED:
1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit:
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. . Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.
Additional Forms REQUIRED Prior to Appointment:
- Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation - A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. .
- Form I-9, Employment Verification and the Electronic Eligibility Verification Program - CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. .
- Standard Form 61, Appointment Affidavits - If selected, the Standard Form 61 will be required at the time of in-processing. .
