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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:

    • 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

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/585085000. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.