As a Nurse Consultant at the GS-0610-14, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will be responsible for implementing overall medical disputed claims review processes, functions as a medical consultant to the Postal Service Health Benefits (PSHB) Program Disputed Claims Team and other OPM offices; oversees and/or participates in the education and training of Legal Administrative Specialist (LAS) in appeal decisions.

Duties

Participates in decision making with the Associate Director, Assistant Director and other OPM senior staff concerning major health benefit coverage issues affecting both OPM and the PSHB Program. Supports Postal Service Insurance Operations (PSIO) and the Office of the General Counsel (OGC) in legal suits relating to disputed claims appeals. Provides PSIO leadership with a monthly analysis of medical disputed claims cases and determinations. Researches medical techniques and services that have been denied by Carriers and educates LAS on evolving claims administration practices for particular medical issues.

Requirements

Qualifications

EDUCATIONAL REQUIREMENTS: 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, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Licensure: You must have passed the National Council Licensure Examination. 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. For the GS14: You must have 1 year (52 weeks) specialized experience which is equivalent in difficulty and complexity to the GS-13 grade level in the Federal service that demonstrates broad knowledge of the functions, processes, and principles of management; and ALL of the following: 1) Coordinates the administration medical review process by providing technical advice and guidance on disputed claims; 2) Ensures compliance of medical decisions with contractual provisions, limitations, and exclusions; 3) Develops project plans and keeps management informed of developments; 4) Researches medical techniques and services that have been denied by Carriers evolving claims administration practices for particular medical issues; AND 5)Participates in the evaluation and negotiation of medical aspects of Carriers' benefit proposals. You must meet all qualification and eligibility requirements by the closing date of this announcement. 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

This position has a basic education requirement listed under the Qualifications section of this announcement.

Contacts

• Address OPM Human Resources 1900 E St., NW Washington, DC 20415 US
• Name: OPM Human Resources
• Phone: 202-606-9321
• Email: [email protected]