This position is located in the Dept. of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management (OFM), Div. of Medicare Advantage and Drug Error Rate, Payment Accuracy and Report Group. As a Nurse (Program Vulnerability Detection & Prevention), GS-0610-11/12, you will provide clinical guidance as part of CMS program policy or support teams, responsible for interpreting applicable laws, regulations, and policies for CMS insurance programs.

Duties

Identify trends and problem areas and recommends needed revisions to existing program policies, criteria, standards, and procedures. Coordinate with stakeholders to develop solutions to program problems. Work with CMS components on data interpretation, recovery audits, claims processing and payment, medical review, and appeals to ensure accurate implementation of clinical healthcare policy. Track effectiveness of corrective actions to identify, monitor, and mitigate program vulnerabilities and reduce improper payments.

Requirements

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.

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. BASIC REQUIREMENT(S): Education: A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education (external link), Council on Accreditation of Nurse Anesthesia Educational Programs (external link), Accreditation Commission for Midwifery Education (external link), or an accrediting body recognized by the U.S. Department of Education (external link) at the time the degree was obtained. You MUST submit a copy of your transcripts at the time of application. Unofficial transcripts will be accepted at the time of application. Official transcripts will be required from all selectees prior to receiving an official offer. Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools (external link) is required for individuals who graduated from foreign nursing schools. Licensure: For all grade levels for this position, you must have passed the National Council Licensure Examination (external link). In addition, you must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. Proof of license/registration MUST be submitted at the time of application. Failure to submit proof of license/registration at the time of application WILL result in an ineligible rating. Basic Requirement for the GS-11 Grade Level: In addition to the mandatory education and licensure requirements listed above, you must meet one of the following: In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector), to include: Assisting in identifying program vulnerabilities that impact medical/nursing elements of the healthcare delivery system; AND possession of a diploma, associate degree, bachelor's degree, or master's degree from a professional nursing educational program. -OR- Possess a Ph.D. or equivalent doctoral degree from a professional nursing educational program or related medical science field. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION) TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application. Basic Requirement for the GS-12 Grade Level: In addition to the mandatory education and licensure requirements listed above, you must meet the following: In order to qualify for the GS-12, 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: Identifying program vulnerabilities that impact medical/nursing elements of the healthcare delivery system; AND possession of a diploma, associate degree, bachelor's degree, or master's degree from a professional nursing educational program. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level. 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.

Education

You are strongly encouraged to submit a copy of your transcripts at the time of application. Unofficial transcripts will be accepted at the time of application. Official transcripts will be required from all selectees prior to receiving an official offer.

License/Registration Requirement: In addition to meeting the qualification requirements, all candidates must possess the license/registration listed below. Proof of license/registration MUST be submitted at the time of application. Failure to submit proof of license/registration at the time of application WILL result in an ineligible rating.

Proof of License/Registration is required at the time of application to verify possession of the license/registration listed above. Failure to submit proof of license/registration at the time of application WILL result in an ineligible rating. Please see the "Required Documents" section below for more information.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12375140

Contacts

• Address Office of Financial Management 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]