Duties

Summary

This position is located in the Performance Improvement Group (PI) within OPM's Federal Employee Insurance Operations, Healthcare and Insurance (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, complex analysis, 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 and FEDVIP 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
• Complete the initial online assessment and USAHire Assessment, if required

Qualifications

For the GS 13 Grade Level: Applicants must have one year of specialized experience equivalent to the GS-12 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:

- Participation in the 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.

- Participation in the evaluation of program quality, customer service, and resource use/cost in any healthcare, insurance, or business setting.

For the GS 14 Grade Level: Applicants 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.

Merit promotion applicants must meet time-in-grade requirement as defined in 5 CFR 300, Subpart F. One year at the GS-12 Grade Level is required to meet the time-in-grade requirements for the GS-13 level. One year at the GS-13 Grade Level is required to meet the time-in-grade requirements for the GS-14 level.

You must meet all qualification and eligibility requirements within 30 days of 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.

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

Veterans Employment Opportunity Act (VEOA): To be eligible for a VEOA appointment under Merit Promotion procedures, the veteran must be a preference eligible or a veteran separated after 3 years or more of continuous active service performed under honorable conditions.

Noncompetitive Appointment Authorities: For more information on noncompetitive appointment authority eligibility
requirements visit the following websites:

• Persons with Disabilities-Schedule A
• Special Hiring Authorities for Veterans
• Special Hiring Authority for Certain Military Spouses
• Other Special Appointment Authorities

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

Reasonable Accommodation Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a reasonable accommodation in your online application. Requests for Reasonable Accommodations for the USA Hire Competency Based Assessments and appropriate supporting documentation for Reasonable Accommodation must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for Reasonable Accommodations are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a Reasonable Accommodation, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire

How You Will Be Evaluated

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

Once the application process is complete, your resume and supporting documentation will be used to determine whether you meet the job qualifications listed on this announcement. If you are minimally qualified for this job, your resume and supporting documentation will be compared to your responses on the Occupational Questionnaire. If you rate yourself higher than is supported by your application materials, your responses may be adjusted and/or you may be excluded from consideration for this job. Your qualifications will be evaluated on the following competencies(knowledge, skills, abilities and other characteristics):

• Accountability
• Analytical Skill
• Attention to Detail
• Communication
• Customer Service
• Flexibility
• Influencing/Negotiating
• Integrity/Honesty
• Interpersonal Skills
• Knowledge of Federal Insurance Benefit Programs
• Learning
• Quality Ranking Factor
• Self-Management
• Stress Tolerance
• Teamwork

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).

In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.

The assessment includes a cut score based on the minimum level of required proficiency in these critical general competencies. You must meet or exceed the cut score to be considered. You will not be considered for the position if you score below the cut score or fail to complete the assessment.

All qualified Non Competitive applicants and the best qualified Merit Promotion applicants will be referred to the hiring manager for consideration.

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 85 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
Other

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 listing work schedule, hours worked per week, dates of employment and duties performed.

Other supporting documents:

• Cover Letter, optional
• If you are requesting a reasonable accommodation to the USA Hire Competency Based Assessments, submit documentation to support your request including the Reasonable Accommodation Request Form found here .
• Your most recent Promotion, Within Rate Increase (WRI/WGI), or Appointment/Conversion SF-50 or Notification of Personnel Action (if applying as a current or former Federal Employee) showing you are/were in the competitive service and the highest grade or promotion potential held.
• Most recent Performance Appraisal, if applicable
• 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
• Veterans Employment Opportunity Act, Veterans Recruitment Appointment, and 30% Disabled Veteran Eligible: DD-214, SF-15 Form and VA letter, or certification of expected discharge or release from active duty under honorable conditions within 120 days
• Schedule A, Persons with Disabilities Appointment Eligibles: Schedule A letter from a physician, local, state or federal rehabilitation office citing your eligibility under 5 CFR 213.3102 (u).
• Certain Family Members Eligible under E.O. 12721: Your most recent non-award SF-50 and performance appraisal.
• Certain Military Spouses Eligible under E.O. 13473: Permanent Change of Station (PCS) orders, that lists you as authorized to accompany the Military member to the new duty permanent station; OR verification of the member's 100% disability (VA Letter); and/or verification of the member's death while on active duty (DD-1300 and Death Certificate) AND verification of the marriage to the service member (i.e., a marriage license or other legal documentation verifying marriage).
• Interchange Agreement with Other Merit Systems Eligible: Documentation of eligibility as listed in each individual interchange agreement.

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.