Clarification from the agency

Current Federal employees serving under career or career-conditional competitive service appointments, former Federal employees with reinstatement eligibility, or persons eligible for non-competitive appointment under special appointment authorities. Veterans who are preference eligible or separated from the armed forces under honorable conditions after 3 or more years of continuous service may apply under the Veterans Employment Opportunity Act (VEOA).

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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.

Conditions of employment

• U.S Citizenship is required.
• Registration with the Selective Service (if applicable).
• Suitability for Federal employment determined by background investigation.
• One-year probationary period may be required.
• Public Financial Disclosure Report is required.

Qualifications

Specialized experience: To meet the minimum qualifications for this position, candidates must possess specialized experience at a senior level which demonstrates ability to perform the duties of the position, including progressively responsible experience directly related to the skills and abilities outlined under the Mandatory Technical Qualifications (TQs) listed below. Your resume must clearly reflect specialized experience that includes providing expert advice on current and emerging managed care, oversight and compliance of managed care entities and Providers, sophisticated analytical skills, superior written and oral communication skills, good judgment, and experience in interacting with government and nongovernment officials. 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.

Technical Qualifications (TQs) - Mandatory; your resume (5 page limit) must clearly show that you possess the following TQs:

1. Demonstrated ability to lead comprehensive strategic initiatives regarding issues in managed care and develop innovative strategies to provide oversight and compliance of managed care organizations and Providers that contract with those organizations.

2. Demonstrated experience gathering, integrating and analyzing sufficient, relevant information from various sources to support effective, timely and transparent decision-making and effectively communicating that information to a range of executives to empower sound decision-making.

3. Demonstrated experience providing expert advice regarding a wide range of managed care issues. These include: relevant Managed care laws, regulations, and guidance, Executive Orders, industry trends, emerging best practices, and developments in case law, as well as, specific managed care topics such as risk adjustment methodologies, actuarial equivalence, quality of care, network adequacy, denials and appeals of services, risks of fraud from providers and managed care organizations, adequacy of data submitted by States and managed care organizations, increased adoption of telehealth, and other issues regarding Medicaid and Medicare managed care implementation.

How you will be evaluated

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

Your eligibility for consideration and qualifications for the position will be determined based upon a review of your detailed resume and your responses to job specific self-assessment questions. Your resume will be evaluated based on evidence of your ability to demonstrate possession of any specialized experience and how well your background and experience relates to the self-assessment questions in the job announcement.

Application packages will be reviewed for completeness. Incomplete or late packages will not receive further consideration.

Basic qualifications review. Your resume and questionnaire responses will e reviewed to ensure that you meet the Specialized Experience and Mandatory Technical Qualifications (TQs) requirement. If you do not meet this requirement, you may not receive further consideration.

If it is determined that you met the basic qualifications for the position, your application package will be further evaluated by a rating and ranking panel, and highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.

All information concerning qualifications is subject to investigation. You should expect that we will
verify performance, suitability, and security background information and take that information into account in making employment offers. False representation may be grounds for non-consideration,
non-selection, and/or appropriate disciplinary action.

This agency uses Category Rating Procedures. If you meet the minimum qualifications, you will be placed in one of the following categories:

Best Qualified: Applicants possessing a background that demonstrates a superior level of all evaluation criteria.
Well Qualified: Applicants possessing a background that demonstrates a satisfactory level of evaluation criteria.
Qualified: Applicants possessing the basic qualifications, with general knowledge, skills and abilities.

If, after reviewing your resume and any supporting documentation, a determination is made that you have rated yourself higher than is supported by your application materials, your responses will be adjusted and/or you may be excluded from consideration for this job.

Please note that a complete application is required for consideration. (Please review the "Required Documents" section of this job announcement to see what must be included in a complete application).

To view the application form, visit: https://apply.usastaffing.gov/ViewQuestionnaire/10967230