This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS), Managed Care Group (MCG). As a Health Insurance Specialist, GS-0107-13, you will focus on developing, evaluating, and implementing CMS Managed Care policies. In this role, you will be leading and participating in projects to enhance the division's efficiency and effectiveness.

Duties

Establishes Medicaid policy related to Medicaid Managed Care programs and other policy areas of responsibility that are located within the division. Advises on evaluating proposed new legislation and regulations to assess their impact on Medicaid prescription drug programs and Managed Care policies to enhance program operations and beneficiary services. Performs independent analyses of Medicaid Managed Care programs and other policy areas to address issues affecting the effective management of Medicaid programs. Processes and reviews state managed care program reports, network adequacy, and mental health parity documentation to ensure compliance with federal rules and requirements for Medicaid Managed Care plans. Coordinates program assignments with internal and external stakeholders as required to diagnose problems and develop viable courses of action. Provides specific and detailed information regarding operational policy and instructions for Medicaid Managed Care programs and policy or other policy areas of responsibility that are located within the division.

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. In order to qualify for the GS-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Develop or implement Managed care program or similar national healthcare program policies; AND (2) Implement operational procedure development to ensure regulations compliance; AND (3) Provide technical assistance to ensure delivery of quality health care services. 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: https://apply.usastaffing.gov/ViewQuestionnaire/12512348

Education

This job does not have an education qualification requirement.

Contacts

• Address Center for Medicaid and CHIP Services 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]