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-0107-14, you will serve as an expert leading a technical team. Your role involves developing research strategies, managing data collection, advising on complex beneficiary issues, and shaping key Federal program decisions and proposals.

Duties

Provides technical expertise for Medicaid Managed care projects analyzing policy issues and topics for the program area. Ensure that state and Medicaid managed care plans are operating in compliance with all Federal rules and requirements. Reviews Managed care plan network adequacy data to ensure that Medicaid managed care plan networks can provide timely access to care for all Medicaid services and benefits. Conducts program-related studies and data analysis regarding quality of care, program oversight, utilization of program services by beneficiaries, or program payments. Interprets intent of statutes to produce federal regulations, policy statements, and other program guidance for Medicaid Managed Care for federal and state health plans.

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-14, 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Providing expert technical guidance on Medicaid Managed Care policies and programs for federal or state health care plans; AND (2) Drafting health policy statements, guidelines, or procedural instructions to implement health care initiatives; AND (3) Advising and collaborating with various stakeholders for policy development, implementation, and program improvement. 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/12567289

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]