Senior Advisor for Managed Care
- Employer
- USAJobs
- Location
- Washington, D.C
- Closing date
- Dec 6, 2020
View more
- Industry
- Government and Public Services, Federal
- Function
- Administrative
- Hours
- Full Time
- Career Level
- Experienced (Non-Manager)
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Duties
Summary
This position is located in the Department of Health And Human Services, Office of Inspector General, Office of Audit Services.
The Office of Audit Services is responsible for protecting the integrity of HHS operations and programs by conducting audits that identify and report ways to improve the economy, efficiency and effectiveness of HHS programs, and help reduce fraud, waste, abuse and mismanagement.
Learn more about this agency
Responsibilities
The Senior Advisor for Managed Care will be responsible for spearheading comprehensive, enterprise wide strategies and deployment plans for managed care that meet HHS OIG policy objectives and legal requirements.
As Senior Advisor for Managed Care, you will provide expert technical advice and guidance to senior management officials on managed care issues including advice regarding emerging issues related to managed care issues and the potential impact of the emerging issues on HHS and/or HHS program beneficiaries.
Duties of this Senior Level position include, but are not limited to:
Travel Required
25% or less - You may be expected to travel for this position.
Supervisory status
No
Promotion Potential
00
Requirements
Conditions of Employment
Qualifications
Specialized experience: To meet the minimum qualifications for this position, candidates must possess specialized experience at a senior level which demonstrates ability to perform the duties of the position, including progressively responsible experience directly related to the skills and abilities outlined under the Mandatory Technical Qualifications (TQs) listed below. Your resume must clearly reflect specialized experience that includes providing expert advice on current and emerging managed care, oversight and compliance of managed care entities and Providers, sophisticated analytical skills, superior written and oral communication skills, good judgment, and experience in interacting with government and nongovernment officials. 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.
Technical Qualifications (TQs) - Mandatory; your resume (5 page limit) must clearly show that you possess the following TQs:
1. Demonstrated ability to lead comprehensive strategic initiatives regarding issues in managed care and develop innovative strategies to provide oversight and compliance of managed care organizations and Providers that contract with those organizations.
2. Demonstrated experience gathering, integrating and analyzing sufficient, relevant information from various sources to support effective, timely and transparent decision-making and effectively communicating that information to a range of executives to empower sound decision-making.
3. Demonstrated experience providing expert advice regarding a wide range of managed care issues. These include: relevant Managed care laws, regulations, and guidance, Executive Orders, industry trends, emerging best practices, and developments in case law, as well as, specific managed care topics such as risk adjustment methodologies, actuarial equivalence, quality of care, network adequacy, denials and appeals of services, risks of fraud from providers and managed care organizations, adequacy of data submitted by States and managed care organizations, increased adoption of telehealth, and other issues regarding Medicaid and Medicare managed care implementation.
Education
There is no positive education requirement for this position.
Additional information
This position is a Senior Level (SL) position in the federal government. Senior Level employees are in nonexecutive positions whose duties are broad and complex enough to be classified above GS-15 level. Senior Level positions involve highly specialized and complex work.
To learn more about Senior Level (SL) positions in the Federal Government, visit OPM's website at https://www.opm.gov/policy-dataoversight/ senior-executive-service/scientific-senior-level-positions
Security and Background Requirements: A background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
Financial Disclosure: This position is subject to public financial disclosure requirements and must be filed within 30 days of the appointment. For more information about Financial Disclosure and OGE Form 278, you may go to the Office of Government Ethics website at https:// www.oge.gov and select Financial Disclosure.
E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.
Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.
Career Transition Program (CTAP) and Interagency Career Transition Assistance Program (ICTAP) Documentation: If you are a displaced or surplus Federal employee eligible for consideration under the CTAP or ICTAP, you MUST submit proof of eligibility. Appropriate documentation such as a reduction-in-force (RIF) separation notice, an SF-50 reflecting your RIF separation, or a notice of proposed removal for declining a directed reassignment or transfer of function to another commuting area. You MUST also submit documentation to reflect your current (or last) performance rating of record along with your application package. Those eligible for consideration will need to be rated as well-qualified at 85.0 or above on the rating criteria for this position in order to exercise selection priority. For more information about ICTAP, go to: http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition.
EEO Statement: HHS is an equal opportunity employer. Selection for this position will be based solely on merit without regard to race, color, religion, age, gender, national origin, political affiliation, disability, sexual orientation, marital or family status, or other differences.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Your eligibility for consideration and qualifications for the position will be determined based upon a review of your detailed resume and your responses to job specific self-assessment questions. Your resume will be evaluated based on evidence of your ability to demonstrate possession of any specialized experience and how well your background and experience relates to the self-assessment questions in the job announcement.
Application packages will be reviewed for completeness. Incomplete or late packages will not receive further consideration.
Basic qualifications review. Your resume and questionnaire responses will e reviewed to ensure that you meet the Specialized Experience and Mandatory Technical Qualifications (TQs) requirement. If you do not meet this requirement, you may not receive further consideration.
If it is determined that you met the basic qualifications for the position, your application package will be further evaluated by a rating and ranking panel, and highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.
All information concerning qualifications is subject to investigation. You should expect that we will
verify performance, suitability, and security background information and take that information into account in making employment offers. False representation may be grounds for non-consideration,
non-selection, and/or appropriate disciplinary action.
This agency uses Category Rating Procedures. If you meet the minimum qualifications, you will be placed in one of the following categories:
Best Qualified: Applicants possessing a background that demonstrates a superior level of all evaluation criteria.
Well Qualified: Applicants possessing a background that demonstrates a satisfactory level of evaluation criteria.
Qualified: Applicants possessing the basic qualifications, with general knowledge, skills and abilities.
If, after reviewing your resume and any supporting documentation, a determination is made that you have rated yourself higher than is supported by your application materials, your responses will be adjusted and/or you may be excluded from consideration for this job.
Please note that a complete application is required for consideration. (Please review the "Required Documents" section of this job announcement to see what must be included in a complete application).
To view the application form, visit: https://apply.usastaffing.gov/ViewQuestionnaire/10967230
Background checks and security clearance
Security clearance
Top Secret
Drug test required
Yes
Position sensitivity and risk
Critical-Sensitive (CS)/High Risk
Trust determination process
Suitability/Fitness
Required Documents
All applicants are required to submit the following supporting document type(s):
Applicants may also submit the following supporting document type(s), which may not be required for all applicants:
We strongly encourage applicants to submit a resume that is tailored specifically for this Senior Level position to ensure it includes relevant examples of hoy you possess the required specialized experience and mandatory Technical Qualifications (TQs). Your resume should emphasize
your level or responsibilities, the scope and complexity of programs managed and program accomplishments, including the results of your actions. Applicants typically provide the following information on their resume:
Do NOT include Personally Identifiable Information (PII) such as social security number or date of birth on your resume, cover letter, or any other document.
For Most Effective Resumes Tips visit: https://help.usajobs.gov/index.php/Most_Effective_Resumes
Please visit the YouTube Link for additional Tips: https://www.youtube.com/watch?v=bqYkibnuiJU
APPLICATION MATERIALS MUST BE RECEIVED BY 11:59 pm (EASTERN TIME) ON 12/14/2020.
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education .
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Summary
This position is located in the Department of Health And Human Services, Office of Inspector General, Office of Audit Services.
The Office of Audit Services is responsible for protecting the integrity of HHS operations and programs by conducting audits that identify and report ways to improve the economy, efficiency and effectiveness of HHS programs, and help reduce fraud, waste, abuse and mismanagement.
Learn more about this agency
Responsibilities
The Senior Advisor for Managed Care will be responsible for spearheading comprehensive, enterprise wide strategies and deployment plans for managed care that meet HHS OIG policy objectives and legal requirements.
As Senior Advisor for Managed Care, you will provide expert technical advice and guidance to senior management officials on managed care issues including advice regarding emerging issues related to managed care issues and the potential impact of the emerging issues on HHS and/or HHS program beneficiaries.
Duties of this Senior Level position include, but are not limited to:
- Developing innovative strategies to provide oversight of managed care organizations and Providers that contract with those organizations.
- Advising OIG personnel on managed care and emerging issues and its impact to audits, evaluations, and investigations as well as the impact on policies, guidelines, and standards.
- Functioning as Subject Matter Expert regarding a wide range of managed care issues. These include risk adjustment methodologies, actuarial equivalence, the fee-for-service adjuster, quality of care organizations, network adequacy, denials and appeal of service, proper beneficiary enrollment.
- Providing expert advice regarding risks of fraud from Providers and managed care organizations, adequacy of data submitted by States and managed care organizations, use of data for compliance, increased adoption of telehealth, and other issues regarding Medicaid and Medicare managed care implementation.
- Determining and advising on the variety and complexities of Medicaid managed care programs and contracts and its impact on OIG oversight activities.
- Promoting effective communication throughout OIG on managed care issues and activities.
- Serving as central point of contact for OIG officials and staff and working with components to address Departmental requests for information and developing strategies to consult effectively with the Department on managed care issues consistent with the IG Act.
- Representing the Deputy IG for Audit Services and other OIG officials at meetings, policy-making conferences and workgroups with other HHS officials, other government agencies, including congressional communities, Members of Congress and their respective staffs, and professional organizations in matter directly or indirectly impacting on assigned areas of responsibility.
Travel Required
25% or less - You may be expected to travel for this position.
Supervisory status
No
Promotion Potential
00
Requirements
Conditions of Employment
- U.S Citizenship is required.
- Registration with the Selective Service (if applicable).
- Suitability for Federal employment determined by background investigation.
- One-year probationary period may be required.
- Public Financial Disclosure Report is required.
Qualifications
Specialized experience: To meet the minimum qualifications for this position, candidates must possess specialized experience at a senior level which demonstrates ability to perform the duties of the position, including progressively responsible experience directly related to the skills and abilities outlined under the Mandatory Technical Qualifications (TQs) listed below. Your resume must clearly reflect specialized experience that includes providing expert advice on current and emerging managed care, oversight and compliance of managed care entities and Providers, sophisticated analytical skills, superior written and oral communication skills, good judgment, and experience in interacting with government and nongovernment officials. 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.
Technical Qualifications (TQs) - Mandatory; your resume (5 page limit) must clearly show that you possess the following TQs:
1. Demonstrated ability to lead comprehensive strategic initiatives regarding issues in managed care and develop innovative strategies to provide oversight and compliance of managed care organizations and Providers that contract with those organizations.
2. Demonstrated experience gathering, integrating and analyzing sufficient, relevant information from various sources to support effective, timely and transparent decision-making and effectively communicating that information to a range of executives to empower sound decision-making.
3. Demonstrated experience providing expert advice regarding a wide range of managed care issues. These include: relevant Managed care laws, regulations, and guidance, Executive Orders, industry trends, emerging best practices, and developments in case law, as well as, specific managed care topics such as risk adjustment methodologies, actuarial equivalence, quality of care, network adequacy, denials and appeals of services, risks of fraud from providers and managed care organizations, adequacy of data submitted by States and managed care organizations, increased adoption of telehealth, and other issues regarding Medicaid and Medicare managed care implementation.
Education
There is no positive education requirement for this position.
Additional information
This position is a Senior Level (SL) position in the federal government. Senior Level employees are in nonexecutive positions whose duties are broad and complex enough to be classified above GS-15 level. Senior Level positions involve highly specialized and complex work.
To learn more about Senior Level (SL) positions in the Federal Government, visit OPM's website at https://www.opm.gov/policy-dataoversight/ senior-executive-service/scientific-senior-level-positions
Security and Background Requirements: A background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
Financial Disclosure: This position is subject to public financial disclosure requirements and must be filed within 30 days of the appointment. For more information about Financial Disclosure and OGE Form 278, you may go to the Office of Government Ethics website at https:// www.oge.gov and select Financial Disclosure.
E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.
Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.
Career Transition Program (CTAP) and Interagency Career Transition Assistance Program (ICTAP) Documentation: If you are a displaced or surplus Federal employee eligible for consideration under the CTAP or ICTAP, you MUST submit proof of eligibility. Appropriate documentation such as a reduction-in-force (RIF) separation notice, an SF-50 reflecting your RIF separation, or a notice of proposed removal for declining a directed reassignment or transfer of function to another commuting area. You MUST also submit documentation to reflect your current (or last) performance rating of record along with your application package. Those eligible for consideration will need to be rated as well-qualified at 85.0 or above on the rating criteria for this position in order to exercise selection priority. For more information about ICTAP, go to: http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition.
EEO Statement: HHS is an equal opportunity employer. Selection for this position will be based solely on merit without regard to race, color, religion, age, gender, national origin, political affiliation, disability, sexual orientation, marital or family status, or other differences.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Your eligibility for consideration and qualifications for the position will be determined based upon a review of your detailed resume and your responses to job specific self-assessment questions. Your resume will be evaluated based on evidence of your ability to demonstrate possession of any specialized experience and how well your background and experience relates to the self-assessment questions in the job announcement.
Application packages will be reviewed for completeness. Incomplete or late packages will not receive further consideration.
Basic qualifications review. Your resume and questionnaire responses will e reviewed to ensure that you meet the Specialized Experience and Mandatory Technical Qualifications (TQs) requirement. If you do not meet this requirement, you may not receive further consideration.
If it is determined that you met the basic qualifications for the position, your application package will be further evaluated by a rating and ranking panel, and highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.
All information concerning qualifications is subject to investigation. You should expect that we will
verify performance, suitability, and security background information and take that information into account in making employment offers. False representation may be grounds for non-consideration,
non-selection, and/or appropriate disciplinary action.
This agency uses Category Rating Procedures. If you meet the minimum qualifications, you will be placed in one of the following categories:
Best Qualified: Applicants possessing a background that demonstrates a superior level of all evaluation criteria.
Well Qualified: Applicants possessing a background that demonstrates a satisfactory level of evaluation criteria.
Qualified: Applicants possessing the basic qualifications, with general knowledge, skills and abilities.
If, after reviewing your resume and any supporting documentation, a determination is made that you have rated yourself higher than is supported by your application materials, your responses will be adjusted and/or you may be excluded from consideration for this job.
Please note that a complete application is required for consideration. (Please review the "Required Documents" section of this job announcement to see what must be included in a complete application).
To view the application form, visit: https://apply.usastaffing.gov/ViewQuestionnaire/10967230
Background checks and security clearance
Security clearance
Top Secret
Drug test required
Yes
Position sensitivity and risk
Critical-Sensitive (CS)/High Risk
Trust determination process
Suitability/Fitness
Required Documents
All applicants are required to submit the following supporting document type(s):
- Resume (limited to 5 pages)
- Responses to the Assessment Questionnaire
- Most Recent SF-50 (indicating time in grade, highest grade and step attained
Applicants may also submit the following supporting document type(s), which may not be required for all applicants:
- Other Supporting Documents: (Only submit if applicable to you)
- College transcript (if qualifying all or in part based on your education
- Veterans' Preference documentation - If you are a veteran, you must submit a copy of your DD Form 214, Certificate of Release or Discharge from Active Duty (Member Copy - 4) and, if applicable, and Application for 10-Point Veterans Preference and an official document dated 1991 or later, from the Department of Veterans Affairs or from a branch of the Armed Forces that supports your claim.
- CTAP/ICTAP documentation
- Political Appointment - OPM must authorize any employment offers we make to current or former (within the last 5 years) Political,
Schedule A, Schedule C, or noncareer SES employees in the executive branch. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C, or noncareer SES employee in executive branch, your resume must reflect such appointment and you must inform Human Resources by providing a copy of appointment SF-50.
We strongly encourage applicants to submit a resume that is tailored specifically for this Senior Level position to ensure it includes relevant examples of hoy you possess the required specialized experience and mandatory Technical Qualifications (TQs). Your resume should emphasize
your level or responsibilities, the scope and complexity of programs managed and program accomplishments, including the results of your actions. Applicants typically provide the following information on their resume:
- Vacancy announcement number and title of positions - HHS-OIG-SL-0501-20-10967230
- Full name, mailing and email addresses, day and evening telephone numbers
- Education information, including colleges or universities attended, as well as type of degrees received and certifications
- Information about paid and unpaid work experience related to the position, including: title, duties and accomplishments, employer's name. duration of employment and grade (if Federal)
- Information about honors, awards and special accomplishments
Do NOT include Personally Identifiable Information (PII) such as social security number or date of birth on your resume, cover letter, or any other document.
For Most Effective Resumes Tips visit: https://help.usajobs.gov/index.php/Most_Effective_Resumes
Please visit the YouTube Link for additional Tips: https://www.youtube.com/watch?v=bqYkibnuiJU
APPLICATION MATERIALS MUST BE RECEIVED BY 11:59 pm (EASTERN TIME) ON 12/14/2020.
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education .
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
You need to sign in or create an account to save a job.
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