Job Listing
Nurse
Centers for Medicare & Medicaid Services · Posted 53 days ago
About the Role
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Data Analytics & Systems Group. As a Nurse, GS-0610-13, you will provide clinical/nursing guidance for CMS policy teams handling difficult or sensitive issues in Medicare/Medicaid programs, and a contact for questions from beneficiaries, providers, contractors, and others about clinical concerns and ways to protect CMS programs.
What You'll Do
- →Apply a wide range of software, systems, and analytical platforms to identify overpayments and detect fraud/abuse across Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
- →Develop algorithms/models, conducting data mining, and providing clinical and analytical decision support to improve the efficiency and effectiveness of program integrity operations.
- →Review Federal laws, regulations, and procedural guidelines to advise leadership on technical flaws and regional impacts of proposed policy changes.
- →Develop guidelines and procedures for reviewing clinical data to determine whether beneficiaries are receiving medically necessary care at appropriate levels of service.
- →Utilize nursing expertise to refine or develop implementing regulations and methods for addressing healthcare coverage and payment determinations.
- →Maintain a comprehensive outreach/education program to ensure Medicare contractors, beneficiaries, families, Congressional representatives, and community-based partners are informed of program benefits, rights, and responsibilities.
- →Determine training needs, develop/conduct regional training for Medicare contractor staff, and serve as a Business Functional Lead, Contracting Officer's Representative (COR), or Government Task Lead (GTL) over contracts and task orders.
- →Represent CMS at meetings, seminars, conferences, and before health organizations, professional panels, and special interest groups on issues related to program vulnerabilities, fraud/abuse detection, and clinical nursing concerns.
- →Speak on behalf of CMS leadership, prepare/present papers, briefing materials, and findings to promote understanding and acceptance of Agency policies at both the regional and national level.
Requirements
- ✓Education Requirement: In addition to meeting the qualification requirements, all candidates must have the following educational requirements: A graduate or higher-level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required.
- ✓This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S.
- ✓Department of Education at the time the degree was obtained; OR a Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools.
- ✓Licensure: For all grade levels and positions, applicants must have passed the National Council Licensure Examination.
- ✓In addition, they must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
- ✓Exemption: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied.
- ✓TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above.
- ✓Please see "Required Documents" section below for what documentation is required at the time of application.
- ✓Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13019703
Personality Fit
Job ID: bdb69cfb-7863-4330-8f5e-1f0ec88a94e6
Posted via USAJobs