Director, Offices of Hearings and Inquiries

Employer
USAJobs
Location
Baltimore, Maryland
Posted
Sep 30, 2022
Closes
Oct 07, 2022
Function
Executive, Director
Hours
Full Time
Duties

  • Provide executive leadership and direction in the development, implementation and/or resolution of complex Medicare beneficiary inquiries, grievances and requests, including the provision of a methodical systemic root cause analysis.
  • Identify opportunities to improve beneficiary and consumer experience in the accurate resolution of complex Medicare/Marketplace inquiries, grievances and requests for assistance.
  • Direct and oversee all aspects of Medicare Ombudsman activities, including the Medicare Beneficiary Ombudsman, as well as the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Ombudsman.
  • Support expanded external engagement opportunities for the Pharmaceutical and Technology Ombudsman and the Customer Accessibility Resource Staff.
  • Responsible for executive oversight and resolution of all Medicare, Medicaid and Marketplace hearings and appeals not otherwise handled (or exhausted) through other hearing agents.
  • Maintain the integrity of all CMS programs through assuring regulatory and operational compliance conditions are known, assessed, addressed, assured and corrected where necessary.
  • Establish, promote and lead executive governing bodies to ensure numerous agencies, entities and components successfully collaborate in areas relevant to appeals interests and deliberate in a fully informed, efficient and effective manner.
  • Develop and maintain program standards, strategies, plans, programs and projects essential to meeting high priority, mission critical program objectives and ensure strategic and effective relationships with enterprise partners and stakeholders.
  • Direct activities of subordinate groups/offices in their fulfillment of assigned responsibilities associated with processing, adjudicating and communicating appeals determinations and dispositions.
  • Manages agency-wide system to identify and track weekly issues on Medicare Parts A, B, C, and D actions to facilitate resolution of systemic Medicare beneficiary issues.
  • Identify and monitor program vulnerabilities to drive program improvements in Medicare, Medicaid and Marketplace programs as necessary.
  • Serve as agency lead on Section 504 accessibility requirement implementation


Requirements

Conditions of Employment

  • U.S. Citizenship required.
  • Background and/or Security Investigation required.
  • One year SES probationary period required.
  • The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, SF-278, prior to assuming the SES position, annually, and upon termination of employment.
  • Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
  • All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
  • All male applicants born after December 31, 1959, must have registered for the selective service. You will be required to sign a statement certifying his registration, or the applicant must demonstrate exempt status under the Selective Service Law.
  • Only experience obtained by the closing date of this announcement will be considered.


Qualifications

All competitive candidates for SES positions with the Federal Government must demonstrate leadership experience indicative of senior executive level management capability. To meet the minimum qualification requirements for this position, you must show in your resume that you possess the Fundamental Competencies, five Executive Core Qualifications, and the Professional/Technical Qualifications listed below. Evidence of this experience must be incorporated into your five page resume. Separate narratives for the Executive Core Qualifications and/or Professional/Technical Qualifications will not be accepted or considered. Typically, experience of this nature is gained at or above the GS-15 grade level in the Federal service, or its equivalent with state or local government, the private sector, or nongovernmental organizations.

Fundamental Competencies:
Interpersonal Skills, Oral Communication, Integrity/Honesty, Written Communication, Continual Learning, and Public Service Motivation.

Executive Core Qualifications (ECQs)
  • Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment.
  • Leading People: The ability to lead people toward meeting the organization's vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.
  • Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.
  • Business Acumen: The ability to manage human, financial, and information resources strategically.
  • Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals.
  • Professional/Technical Qualifications (PTQs)

    This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume.
  • Demonstrated comprehensive knowledge of a national health insurance program such as Medicare, Medicaid, Marketplace, and/or the state-run Health Insurance Exchange to enable accurate resolution to beneficiary/consumer inquiries, conduct formal hearing and appeals processes and administer ombudsman services.
  • Demonstrated experience leading collaborative studies and initiatives to assess the efficiency and effectiveness of the national health insurance program policies and operations and implementing identified improvements to effect lasting and positive changes that improve beneficiary and consumer experience.
  • Demonstrated experience driving programmatic improvements and process automation in complex regulatory and operational environment associated with health insurance administration.
  • It is STRONGLY recommended that you visit the following Office of Personnel Management (OPM) webpage for more information regarding the Fundamental Competencies and ECQs.
    https://www.opm.gov/policy-data-oversight/senior-executive-service/executive-core-qualifications/#url=Overview

    If selected, you will be required to complete an ECQ package by drafting narratives for each of the ECQs for submission and certification by an OPM Qualifications Review Board (QRB) in order to be placed in this position. If you are currently serving in a career SES appointment, are eligible for reinstatement into the SES, or have successfully completed an SES Candidate Development Program approved by the Office of Personnel Management (OPM), you will not need to draft the ECQs.

    Education

    This job does not have an education qualification requirement.

    Additional information

    Salary for SES positions varies depending on qualifications. The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments.

    Veteran's Preference does not apply to the SES.
    Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.

    Workplace Flexibility at CMS: CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager's discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process.

    To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.