As a Nurse with the US Office of Personnel Management, Healthcare and Insurance, Federal Employees Insurance Operations, Disputed Claims Team, you will serve as a Nurse Consultant supporting medical disputed claims reviews, providing medical analysis and guidance, training staff, consulting on benefit issues, and supporting defensible decisions under the Federal Employees Health Benefits Program.
Summary
As a Nurse with the US Office of Personnel Management, Healthcare and Insurance, Federal Employees Insurance Operations, Disputed Claims Team, you will serve as a Nurse Consultant supporting medical disputed claims reviews, providing medical analysis and guidance, training staff, consulting on benefit issues, and supporting defensible decisions under the Federal Employees Health Benefits Program.
Males born after 12-31-59 must be registered for Selective Service
Suitable for Federal employment, determined by a background investigation
May be required to successfully complete a probationary period
Candidates will not be hired based on their race, sex, color, religion, or national origin
Complete the initial online assessment and USAHire Assessment, if required
You will be required to report to an OPM assigned office.
This position is eligible for inclusion in the bargaining unit. The union that represents employees in this position is the American Federation of Government Employees (AFGE) Local 32.
Licensure Requirement: Applicants must have passed the National Council Licensure Examination. In addition, they must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
Experience Requirements:
For the GS-13 Grade Level: Applicants must have one year of specialized experience equivalent to at least the GS-12 level in the Federal service, or equivalent, performing nursing, health insurance, medical claims, or health benefits review work that includes:
Reviewing medical records, claims information, benefit provisions, or appeal materials to support decisions on health care services, coverage, or medical necessity;
Applying medical terminology, coding information, health care procedures, or clinical standards to evaluate health benefit claims, appeals, or disputed coverage issues;
Preparing written analyses, recommendations, correspondence, or case documentation involving medical claims, health benefits, or insurance coverage issues; and
Providing technical guidance, training, or consultation to staff or stakeholders on medical claims review, health benefit interpretation, or appeal documentation requirements.
For the GS-14 Grade Level:
Applicants must have one year of specialized experience equivalent to at least the GS-13 level in the Federal service, or equivalent, performing nursing, health insurance, medical claims, or health benefits review work that includes:
Independently evaluating medical records, claims information, benefit provisions, or appeal materials to develop recommendations on health care services, coverage, or medical necessity;
Applying medical terminology, coding information, health care procedures, clinical standards, and insurance benefit provisions to resolve disputed claims or coverage issues;
Preparing written medical analyses, recommendations, determinations, correspondence, or case documentation used to support benefit decisions or appeal responses;
Providing technical guidance, training, or consultation to staff, managers, contractors, or stakeholders on medical claims review, health benefit interpretation, or appeal documentation requirements; and
Identifying trends, issues, or process concerns in medical claims or disputed claims review and recommending changes to improve consistency, timeliness, or decision support.
You must meet all qualification and eligibility requirements by the closing date of this announcement.
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.
Education
This position has a basic education requirement listed under the Qualifications section of this announcement.
Additional information
This announcement will be used to fill vacancies through OPM-authorized Direct Hire Authority due to Critical Hiring Need/Severe Shortage of Candidates. Veteran preference and traditional rating/raking of applicants do not apply. For more information on OPM's authorization of Direct Hire Authority, please visit: https://www.opm.gov/policy-data-oversight/hiring-information/direct-hire-authority/
Relocation expenses will not be paid.
This job opportunity announcement may be used to fill additional similar vacancies across OPM.
If you are unable to apply online and would like to request information about the Alternate Application process, please use the contact information at the bottom of this announcement.
Reasonable Accommodation Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a reasonable accommodation in your online application. Requests for Reasonable Accommodations for the USA Hire Competency Based Assessments and appropriate supporting documentation for Reasonable Accommodation must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for Reasonable Accommodations are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a Reasonable Accommodation, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire
As a condition of employment for accepting this position, you may be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:
- your performance and conduct;
- the needs and interests of the agency;
- whether your continued employment would advance organizational goals of the agency or the Government; and
- whether your continued employment would advance the efficiency of the Federal service.
Upon completion of your probationary period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
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.
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.
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.
How you will be evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses on the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):
Attention to Detail
Customer Service
Decision Making
Flexibility
Influencing/Negotiating
Integrity/Honesty
Interpersonal Skills
Learning
Reasoning
Self-Management
Stress Tolerance
Teamwork
Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on an assessment may also result in your removal from consideration.
Career Transition Assistance Programs: These programs apply to employees who have been involuntarily separated from a Federal service position within the competitive service or Federal service employees whose positions have been deemed surplus or no longer needed. To receive selection priority for this position, you must: 1) meet CTAP or ICTAP eligibility criteria; 2) be rated well-qualified for the position (obtain a score of 85 or higher on the assessments); and 3) submit the appropriate documentation to support your CTAP or ICTAP eligibility. For more information visit: http://www.opm.gov/rif/employee_guides/career_transition.asp.
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.
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.
To apply for this position, you must provide a complete Application Package which includes:
Your Resume showing the applicant's name, email address, work schedule, hours worked per week, dates of employment, and duties performed to include pay plan, series, and grade level for relevant federal experience. Your resume must show complete information for each job entry to support minimum qualifications. Only the first 2 pages of the resume/application will be used to verify minimum qualifications. Please be sure to include specific dates of employment and work schedule(s).
Do not include the following types of information in your resume:
Classified or government sensitive information
Social Security Number (SSN)
Photos of yourself
Personal information, such as age, sex, religious affiliation, etc.
Encrypted and digitally signed documents
This position has a basic education requirement; you MUST submit a copy of your transcripts for further consideration.
Proof of Licensure
Other supporting documents:
Cover Letter, optional
Career Transition Assistance Program (CTAP)/Interagency Career Transition Assistance Program (ICTAP)Documentation, if applicable (e.g., Certification of Expected Separation, Reduction-In-Force Separation Notice, or Notice of Proposed Removal; SF-50 that documents the RIF separation action; and most recent performance appraisal.)
If you are requesting a reasonable accommodation to the USA Hire Competency Based Assessments, submit documentation to support your request, including the Reasonable Accommodation Request Form found here.
Failure to submit any of the above-mentioned required documents may result in loss of consideration due to an incomplete application package. It is your responsibility to ensure all required documents have been submitted.?
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on the closing date of the announcement to receive consideration. The application process is as follows:
1. Click the Apply Online button.
2. Answer the questions presented in the application and attach all necessary supporting documentation.
3. Click the Submit Application button prior to 11:59 PM (ET) on the announcement closing date.
4. If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.
5. Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
6. Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
7. Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
8. Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.
To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.
To view the announcement status or your application status: Click on this: https://www.usajobs.gov/Help/how-to/application/status/. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.
OPM Human Resources
1900 E St., NW
Washington, DC 20415
US
Next steps
Once referred, you may be asked to complete a structured interview, written demonstration, and/or fit interview. Deliberate attempts to falsify information may be grounds for not selecting you or for dismissing you from the position/agency during the probationary period.
Once your online application is submitted you will receive a confirmation notification by email. Your application will be evaluated. You will receive another notification about the status of your application.
We expect to make a job offer within 40 days after the closing date of the announcement. After making a tentative job offer, we will conduct a suitability/security background investigation.
An agency may not request, orally, in writing, or electronically through the USA Jobs website or other electronic means, that an applicant for appointment for a position in the civil service disclose criminal history record information before the appointing agency extends a conditional offer of employment. If you believe you were asked about your criminal history improperly, contact the agency or visit https://www.opm.gov/about-us/careers-at-opm/opportunities/
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
To apply for this position, you must provide a complete Application Package which includes:
Your Resume showing the applicant's name, email address, work schedule, hours worked per week, dates of employment, and duties performed to include pay plan, series, and grade level for relevant federal experience. Your resume must show complete information for each job entry to support minimum qualifications. Only the first 2 pages of the resume/application will be used to verify minimum qualifications. Please be sure to include specific dates of employment and work schedule(s).
Do not include the following types of information in your resume:
Classified or government sensitive information
Social Security Number (SSN)
Photos of yourself
Personal information, such as age, sex, religious affiliation, etc.
Encrypted and digitally signed documents
This position has a basic education requirement; you MUST submit a copy of your transcripts for further consideration.
Proof of Licensure
Other supporting documents:
Cover Letter, optional
Career Transition Assistance Program (CTAP)/Interagency Career Transition Assistance Program (ICTAP)Documentation, if applicable (e.g., Certification of Expected Separation, Reduction-In-Force Separation Notice, or Notice of Proposed Removal; SF-50 that documents the RIF separation action; and most recent performance appraisal.)
If you are requesting a reasonable accommodation to the USA Hire Competency Based Assessments, submit documentation to support your request, including the Reasonable Accommodation Request Form found here.
Failure to submit any of the above-mentioned required documents may result in loss of consideration due to an incomplete application package. It is your responsibility to ensure all required documents have been submitted.?
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on the closing date of the announcement to receive consideration. The application process is as follows:
1. Click the Apply Online button.
2. Answer the questions presented in the application and attach all necessary supporting documentation.
3. Click the Submit Application button prior to 11:59 PM (ET) on the announcement closing date.
4. If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.
5. Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
6. Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
7. Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
8. Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.
To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.
To view the announcement status or your application status: Click on this: https://www.usajobs.gov/Help/how-to/application/status/. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.
OPM Human Resources
1900 E St., NW
Washington, DC 20415
US
Next steps
Once referred, you may be asked to complete a structured interview, written demonstration, and/or fit interview. Deliberate attempts to falsify information may be grounds for not selecting you or for dismissing you from the position/agency during the probationary period.
Once your online application is submitted you will receive a confirmation notification by email. Your application will be evaluated. You will receive another notification about the status of your application.
We expect to make a job offer within 40 days after the closing date of the announcement. After making a tentative job offer, we will conduct a suitability/security background investigation.
An agency may not request, orally, in writing, or electronically through the USA Jobs website or other electronic means, that an applicant for appointment for a position in the civil service disclose criminal history record information before the appointing agency extends a conditional offer of employment. If you believe you were asked about your criminal history improperly, contact the agency or visit https://www.opm.gov/about-us/careers-at-opm/opportunities/
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
