Clarification from the agency

All groups of qualified individuals.

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• Promotes integrity in Medicare and Medicaid Programs by developing a national fraud prevention program for payments and provider enrollment, integrating predictive modeling into CMS’ claims processing and provider enrollment system
• Serves as an effective change agent to achieve quality improvement within PI by using data to quickly identify vulnerabilities and areas for action/improvement and planning and re-measuring to ensure effective improvement actions.
• Achieves quality improvement within PI by utilizing technology to analyze datasets to identify patterns and networks that represent a high risk of fraudulent activity and analyzing processes to determine the root cause of such vulnerabilities.
• Oversees the development and maintenance of IT platforms and data access methodologies for detection of fraud and abuse.
• Develops and manages ROI methodologies to report savings associated with fraud prevention systems.
• Develops and maintains Information Technology platforms and data access methodologies for detection of fraud and abuse.
• Exercises executive leadership in the development, vision, strategy, oversight, and implementation of the Agency’s major fraud fighting tools.
• Provides oversight of the development of clinical and data-driven algorithms that run in the IT systems used to detect fraud.

Conditions of employment

• U.S. Citizenship required.
• Background and/or Security Investigation required.
• One year SES probationary period required.
• The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, SF-278, prior to assuming the SES position, annually, and upon termination of employment.
• Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
• All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
• All male applicants born after December 31, 1959, must have registered for the selective service. You will be required to sign a statement certifying his registration, or the applicant must demonstrate exempt status under the Selective Service Law.
• Only experience obtained by the closing date of this announcement will be considered.

Qualifications

All competitive candidates for SES positions with the Federal Government must demonstrate leadership experience indicative of senior executive level management capability. To meet the minimum qualification requirements for this position, you must show in your resume that you possess the Fundamental Competencies, five Executive Core Qualifications, and the Professional/Technical Qualifications listed below. Evidence of this experience must be incorporated into your five page resume. Separate narratives for the Executive Core Qualifications and/or Professional/Technical Qualifications will not be accepted or considered. 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.

Fundamental Competencies:
Interpersonal Skills, Oral Communication, Integrity/Honesty, Written Communication, Continual Learning, and Public Service Motivation.

Executive Core Qualifications (ECQs)

1. Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment.
2. Leading People: The ability to lead people toward meeting the organization's vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.
3. Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.
4. Business Acumen: The ability to manage human, financial, and information resources strategically.
5. Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals.

Professional/Technical Qualifications (PTQs)

This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume.

1. Demonstrated experience in a senior leadership position, dealing and negotiating with a wide range of senior-level information technology (IT) officials in various government agencies, law enforcement organizations, or public and private organizations regarding complex and controversial issues concerning federal programs and the protection of the integrity of these programs.
2. Demonstrated experience in the development and implementation of Program Integrity (PI) prevention and detection initiatives into large-scale IT platforms for the identification of major fraud, waste, and abuse trends.
3. Demonstrated experience in developing and implementing a national fraud prevention IT system that integrates predictive analytics.
4. Demonstrated experience building high-performing teams of IT professionals.
5. Demonstrated experience developing and implementing an organizational-wide IT workforce strategy that attracts, develops, and retains top IT, digital, and cybersecurity talent to continuously analyze and adopt modern technologies, solutions, and processes that drive enhanced business value.

It is STRONGLY recommended that you visit the following Office of Personnel Management (OPM) webpage for more information regarding the Fundamental Competencies and ECQs.
https://www.opm.gov/policy-data-oversight/senior-executive-service/executive-core-qualifications/#url=Overview

If selected, you will be required to complete an ECQ package by drafting narratives for each of the ECQs for submission and certification by an OPM Qualifications Review Board (QRB) in order to be placed in this position. If you are currently serving in a career SES appointment, are eligible for reinstatement into the SES, or have successfully completed an SES Candidate Development Program approved by the Office of Personnel Management (OPM), you will not need to draft the ECQs.

How you will be evaluated

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

We use a multi-step process to evaluate and refer applicants:

1. Minimum requirements: Your application must show that you meet all requirements, including the education and/or experience required for this position. You may be found 'not qualified' if you do not possess the minimum competencies required for the position. If your application is incomplete, we may rate you as ineligible.
2. Rating: A panel of Senior Executives will review your application and evaluate your qualification for this position based on the information in your application. Your application will be rated, based on the extent and quality of your experience, education, and training relevant to the duties of this position. Interviews will be at the discretion of the panel and/or selection official.
3. Referral: If you are among the top qualified candidates, your application will be referred to a selection official for consideration and possible interview.