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Health Insurance Specialist (Program Policy)

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare (CM)
This job announcement has closed

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Medicare Drug Rebate and Negotiations Group (MDRNG).

THIS ANNOUNCEMENT HAS BEEN AMENDED TO CLOSE EARLY ON JULY 14, 2023. THE PURPOSE OF THIS AMENDMENT IS TO COINCIDE WITH THE EXPIRATION DATE OF THE CURRENT DIRECT HIRE AUTHORITY WHICH IS SEPTEMBER 2, 2023. THIS WILL ALLOW MANAGEMENT AMPLE TIME TO REVIEW THE FINAL GROUP OF APPLICANTS.

Overview

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Hiring complete
Open & closing dates
04/13/2023 to 07/14/2023
Salary
$84,546 to - $109,908 per year

This is the BASE salary for the position. Please see "Additional Information" for locality pay rates.

Pay scale & grade
GS 13
Location
Few vacancies in the following location:
Anywhere in the U.S. (remote job)
Remote job
Yes - This is a remote position; however, the position reports to a CMS office on a periodic basis.
Telework eligible
Not applicable, this is a remote position.
Travel Required
Occasional travel - You may be expected to travel up to 5% for this position.
Relocation expenses reimbursed
No
Appointment type
Permanent
Work schedule
Full-time
Service
Competitive
Promotion potential
13
Supervisory status
No
Security clearance
Not Required
Drug test
No
Position sensitivity and risk
Moderate Risk (MR)
Trust determination process
Announcement number
CMS-CM-23-11897330-DH-IRA
Control number
718996000

This job is open to

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Clarification from the agency

This announcement is advertised under Direct Hire Authority and is open to all United States Citizens or Nationals.

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Duties

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  • Interpret statute and develop Federal regulations, policy statements, and other program guidance relating to health insurance programs.
  • Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
  • Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information such as routine and ad hoc report, deliverables, and programmatic documentation.
  • Coordinate and prepare responses to Congressional Inquiries, Office of the Inspector General and Government Accountability Office actions, and other stakeholders and, where appropriate, monitor progress of follow-up actions.
  • Act as an Agency representative and contribute to discussions and planning sessions on program policy developments in external meetings and conferences.
  • Develop project plans to ensure logistics are handled efficiently, identifying potential bottlenecks and resolving issues within the scope of authority.

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.
  • This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.

Qualifications

This announcement is open continuous and will be open until August 2023. An initial cut-off will be made two (2) weeks after the opening date. Additional cut-offs will be made every month thereafter.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume 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 receiving further consideration.


In order to qualify for the GS-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Conducting analysis of program payment or coverage policy for healthcare services in order to propose policy modifications; AND (2) Presenting recommendations based on analysis of program or coverage payment policy issues for healthcare services that describe feasible options and/or consequences; AND (3) Developing program guidance to manage and analyze programmatic information for payment or coverage of healthcare services.

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.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11897330

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/Relocation Incentive: Not Authorized
Financial Disclosure: Not Required

This position will be in direct support of the Inflation Reduction Act of 2022. This Act increases healthcare spending by nearly $100 billion, mainly by extending the American Rescue Plan's temporarily-expanded Affordable Care Act (ACA) premium tax credits for an additional three years, through 2025. The bill will also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer discount program, impose inflation rebates for Part B and Part D drugs, and other miscellaneous changes in Part B and Part D to improve the affordability of prescription drugs.

To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.

Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please click here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.

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 www.opm.gov/rif/employee_guides/career_transition.asp.

How you will be evaluated

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

Traditional rating and ranking of applications does not apply to this vacancy. Applications will be evaluated against the basic qualifications. Qualified candidates will be referred for consideration in accordance with the Office of Personnel Management direct hire guidelines. Veterans' Preference does not apply to direct hire recruitment procedures. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would, therefore, be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

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