Duties

Summary

This position is located in the Performance Improvement Group (PI) within OPM's Federal Employee Insurance Operations, Healthcare and Insurance Division (HI). The incumbent supports the end-to-end operation of the Plan Performance Assessment (PPA) through which FEHB Carriers profit factor is determined. This can include measure curation, score calculation and verification, measure and methodology maintenance, results reporting, data visualization, trend analysis, and related activities.
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Responsibilities

• Recommend new measures for selection, and maintenance of measures evaluated in the PPA, including: identifying new measures, measure updates and retirements, weighting, scoring and analysis of results across the portfolio of FEHB plans.
• Participating in conducting annual plan review for all FEHB carriers to validate or dispute scoring before final results are applied to allowable plan payment formulas.
• Participating in monitoring the PPA to detect vulnerabilities in the measure set or methodology, as well as individual and systematic elements of noncompliance by carriers.
• Drafting and compiling internal and external program documents, including but not limited to PPA Carrier Letters, Operations Manuals, Methodology Manual, reports, white papers, and trend analyses, as well as accreditation programs and patient safety.
• Identifying and preparing presentations and training modules for FEHB Carriers and HI staff.
• Developing and executing internal audit, reconciliation, and controls.
• Outlining internal and external communication of program goals, policy initiatives, and accomplishments on QCR performance areas.
• Elucidating and communicating best practices through PPA data analysis, literature review, or market research.
• Overseeing proper administration of contracts and vendor relationships supporting PPA, including procurement, contractor evaluation, and exercising options.
• Managing the production and approval of PPA content for the OPM website, FEHB brochures, and applicable consumer choice tools supporting Open Season.
• Providing subject matter expertise on quality, customer service, resource use, and business metrics as well as accreditation programs
• Identify, describe, build the business case for, and recommend needed program revisions.
• Interact with FEHB Contracting Officers and actuarial staff to apply PPA scoring to final determination of applicable service charge (experience-rated plans) or performance adjustment (community-rated plans).
• Interact with all groups and divisions within Healthcare and Insurance as related performance improvement projects are prioritized by PI and HI leadership
• Assessing new developments and best practices in quality management, performance improvement, and accreditation.

Travel Required

Not required

Supervisory status
No

Promotion Potential
14

Requirements

Conditions of Employment

• Must be a U.S. Citizen or National
• Males born after 12-31-59 must be registered for Selective Service
• Suitable for Federal employment, determined by a background investigation
• May be required to successfully complete a probationary period

Qualifications

For the GS 14: You must have one year of specialized experience equivalent to the GS-13 Federal grade level. This experience must have been directly related to timely, efficient, precise, and effective performance accountability for health plan quality, and includes the following:

• Development of performance assessments, measure specifications, or methodology for a healthcare performance improvement program as indicated by prior positions at a health plan, health system, healthcare quality organization, or government agency performing related work.
• Evaluation of program quality, customer service, and resource use/cost in any healthcare, insurance, or business setting.

Quality Ranking Factor: Minimum of two years' experience with a healthcare purchaser, payor, and/or healthcare quality organization/measure developer/measure steward, in planning, development, implementation, and execution of a healthcare quality/ performance improvement program. This can be evidenced by relevant prior positions and/or certification as a health care quality professional (Certified Professional in Healthcare Quality, Certified Professional in Healthcare Risk Management, Certified Utilization Management/Credentialing Review, or similar).

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 job does not have an education qualification requirement.

Additional information

Relocation expenses will not be paid. Current OPM employees may qualify as an exception.

The full performance level of this position is GS-14.

This job opportunity announcement may be used to fill additional similar vacancies across OPM.

If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application: https://help.usastaffing.gov/Apply/index.php?title=Alternate_Application_Information

If you are a veteran and you are claiming 5-point veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility.
If you are a veteran and you are claiming 10-point veterans' preference, you must also submit an SF-15, "Application for 10-Point Veterans' Preference" plus the proof required by that form. For more information on veterans' preference click here .

Males born after 12-31-59 must be registered or exempt from Selective Service (see https://www.sss.gov/Home/Registration ).

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

For Category Rating: Once the application process is complete, a review of your resume and supporting documentation will be made and compared against your responses to the assessment questionnaire to determine if you are qualified for this job. If, after reviewing your resume and or supporting documentation, a determination is made that you have inflated your qualifications and or experience, you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your eligibility. Qualified candidates will be assigned to one of the three quality categories: Qualified, Well Qualified, or Best Qualified. Qualified Category = Does not exceed the basic qualifications requirements described in the "Qualifications" section of this announcement. Well Qualified Category = Meets the basic qualifications requirements described in the "Qualifications" section of this announcement and demonstrates proficiency in the Critical Competencies defined below. (This category must be met to be considered under ICTAP procedures) Best Qualified Category = Meets the basic qualifications requirements described in the "Qualifications" section of this announcement and excels in the Critical Competencies defined below. The category assignment is a measure of the degree in which your background matches the competencies required for this position.

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

• Analytical Skill
• Health Insurance Benefits
• Interpersonal Communication
• Problem Solving
• Written Communication

The Category Rating Process does not add veterans' preference points or apply the "rule of three," but protects the rights of veterans by placing them ahead of non-preference eligible within each category. Preference eligibles who meet the minimum qualification requirements and have a compensable service-connected disability of at least 10 percent or higher will be listed in the highest quality category (except in the case of scientific or professional positions at the GS-09 level or higher).

Career Transition Assistance Programs: These programs apply to employees who have been involuntarily separated from a Federal service position within the competitive service or Federal service employees whose positions have been deemed surplus or no longer needed. To receive selection priority for this position, you must: 1) meet CTAP or ICTAP eligibility criteria; 2) be rated well-qualified for the position with a score of 80 or above based on the competencies listed above; and 3) submit the appropriate documentation to support your CTAP or ICTAP eligibility. For more information visit: http://www.opm.gov/rif/employee_guides/career_transition.asp .

Background checks and security clearance

Security clearance
Not Required

Drug test required
No

Position sensitivity and risk
High Risk (HR)

Trust determination process
Credentialing , Suitability/Fitness

Required Documents

To apply for this position, you must provide a complete Application Package which includes:

Your Resume showing work schedule, hours worked per week, dates of employment and duties performed.

Other supporting documents:

• Cover Letter, optional
• Veterans' Preference documentation, if applicable (e.g. DD-214 Member Copy 4 showing type of discharge/character of service; Current Active Duty members must submit a certification of expected discharge or release from active duty under honorable conditions dated within 120 days; SF-15 Form and related documentation; VA letter.)
• Career Transition Assistance Program/Interagency Career Transition Assistance Program documentation, if applicable (e.g. Certification of Expected Separation, Reduction-In-Force Separation Notice, or Notice of Proposed Removal; SF-50 that documents the RIF separation action; and most recent performance appraisal.)
• Worker's Compensation Separation: Agency certification of inability to place employee AND Notification of Separation OR Separation SF-50.
• Disability Annuity Termination: Notification from OPM of disability annuity termination AND Separation SF-50 of the last position held.
• Military Reserve or National Guard Technician Special Disability Retirement Annuity under 5 U.S.C. 8337(h) or 8456: Certification of special disability retirement annuity from a military department or National Guard Bureau AND Separation SF-50 of the last position held

Failure to submit any of the above mentioned required documents may result in loss of consideration due to an incomplete application package. It is your responsibility to ensure all required documents have been submitted.