Health Insurance Specialist

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS), Division of Managed Care (MCG).

As a Health Insurance Specialist, GS-0107-14, you will serve as the technical authority for Medicaid State Directed Payments, leading policy development and Big Beautiful Bill Act (OB3) compliance, providing expert guidance, conducting analyses, and supporting CMS policy and program decisions.

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Duties

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• Serving as a technical authority and providing technical direction and leadership related to Medicaid managed care and other policy related areas.
• Leading the development and implementation for Medicaid managed care new policies and regulations.
• Serving as a technical expert on state directed payments policies and/or operations for Medicaid managed care and coordinates cross-cutting projects
• Leading projects or studies that analyze the efficiency, effectiveness and/or outcomes of Medicaid managed care programs and conducts special assignments on a wide range of significant management, operational, and policy issues.
• Consulting, advising, and briefing leadership on critical policies, procedures, and issues that have a major impact on Medicaid programs.

Requirements

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Conditions of employment

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.
• Time-in-Grade restrictions apply.
• Selective Service: Males born after December 31, 1959, must be registered or exempt from Selective Service -
• One-year probationary period may be required.
• 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.
• All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from being considered further.

In order to qualify for the GS-14 , you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Interpreting and implementing federal statutes and regulations impacting Medicaid managed care to develop program guidance and ensure state compliance; 2. Operationalizing federal regulation requirements pertaining to Medicaid managed care payment policy to ensure state compliance with federal standards; AND 3. Providing technical direction and guidance on Medicaid managed care and payment policy to federal and state stakeholders to support program implementation and policy interpretation.

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.

Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire:

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923

Tour of Duty: Flexible

Recruitment Incentive: Not Authorized

Relocation Incentive: Not Authorized

Financial Disclosure: Not Required

Boston, MA Locality Pay: $142,452 to $185,193

Seattle, WA Locality Pay: $141,367 to $183,782

Woodlawn, MD Locality Pay: $143,913 to $187,093

Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at

Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.