Director, Division Of Investigative Support

Supervisory Health Insurance Specialist

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Division of Investigative Support. As a Supervisory Health Insurance Specialist, referred here as a Director, Division of Investigative Support, GS-0107-15, you will serve as a supervisor, leading a staff who plan, implement, and support CMS program integrity initiatives to prevent, detect and deter fraud, waste, and abuse.

Responsibilities include:

• Leading and coordinating complex health policy and oversight initiatives across Medicare, Medicaid, CHIP, and Marketplace programs to improve program integrity and regulatory compliance.
• Overseeing audits, reviews, and enforcement efforts to prevent improper payments, monitor contractor and provider performance, and address program fraud, waste, and abuse.
• Managing cross-agency and multi-sector projects, including federal-state partnerships and contractor collaborations, to advance strategic health system goals.
• Directing data-driven projects to evaluate program performance, develop policy recommendations, and communicate findings to senior decision-makers through reports and briefings.

Requirements include:

Conditions of employment:

Qualifications: All qualification requirements must be met within 30 days of the closing date of this announcement. Your resume (limited to no more than 2 pages) 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 being considered further.

In order to qualify for the GS-15, 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-14 grade level in the Federal government, obtained in either the private or public sector, to include:
• Overseeing policy, procedural, or operational initiatives aimed at preventing fraud, waste, and abuse in healthcare programs.
• Coordinating with law enforcement, investigators, oversight agencies, or regulatory bodies on healthcare program integrity matters.
• Providing technical guidance and reviewing the work of others involved in enforcement, compliance, or safeguard initiatives in healthcare programs.
• 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.
• Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Additional Information:

Bargaining Unit Position: No

Tour of Duty: Flexible

Recruitment Incentive: Not Authorized

Relocation Incentive: Not Authorized

Financial Disclosure: OGE-450

Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.