Medicare Medicaid Program Integrity Manager Jobs

Summary
This position is located in the Center for Program Integrity (CPI) at the Centers for Medicare & Medicaid Services (CMS).
As the Deputy Center Director (Medicaid Program Integrity), you will provide executive leadership, direction and coordination for the management of a cohesive, agency-wide approach to ensuring program integrity across the Medicaid and Children's Health Insurance Program (CHIP).
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Duties
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• Provides executive leadership and expert knowledge for the agency as it relates to Medicaid program integrity (PI) activities.
• Directs the identification of program vulnerabilities and actions taken to formulate and implement methodologies to strengthen program integrity efforts emerging with fraud, waste, and abuse in the Medicaid and CHIP programs.
• Provides strategic direction and oversight for CPI's engagement with State Medicaid agencies on program integrity activities, including the review and approval of State program integrity plans and corrective action plans.
• Directs CPI's oversight of program integrity activities within Medicaid Managed Care Organizations (MCOs), including the review of encounter data, claims data, and managed care contract compliance.
• Oversees CPI strategic planning, as well as the establishment of performance goals and measures for CPI and its staff.
• Provides guidance to ensure appropriate liaison and coordination with the Department, other HHS Operating Divisions, other Federal agencies and other non-Federal organizations necessary to CPI's program integrity operations.

Requirements
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Conditions of employment

• Must be a U.S. Citizen or National.
• Subject to a 1-year supervisory probationary period (unless already completed).
• Complete a Declaration for Federal Employment to determine your suitability for Federal employment, at the time requested by the agency.
• If you are a male applicant born after December 31, 1959, certify that you have registered with the Selective Service System or are exempt from having to do so.
• May be subject to pre-employment and random drug tests.
• You may be required to obtain and maintain an interim and/or final security clearance prior to entrance on duty. Failure to obtain and maintain the required level of clearance may result in the withdrawal of a job offer or removal.
• The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, OGE-278e, 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.
• Only experience obtained by the closing date of this announcement will be considered.

Qualifications
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. Candidates will not be hired based on their race, sex, color, religion, or national origin.
To meet the minimum qualification requirements for this position, you must show that you possess the Executive Core Qualifications (ECQ) and Technical Qualifications (TQ) related to this position within your resume - NOT TO EXCEED 2 PAGES. Resumes over the 2-page limit, will not be reviewed beyond page 2 or may be disqualified. Your resume should include examples of experience, education, and accomplishments applicable to the qualification(s). If your resume does not reflect demonstrated evidence of these qualifications, you may not receive consideration for the position.
There is NO requirement to prepare a narrative statement specifically addressing the Executive Core Qualifications (ECQs) or the Technical Qualifications (TQs).
TECHNICAL QUALIFICATIONS (TQs): Your resume should demonstrate accomplishments that would satisfy the technical qualifications.
TQ 1: Demonstrated executive-level experience leading national program integrity efforts for Medicaid, the Children's Health Insurance Program (CHIP), or similar Federal health care programs. This includes developing and leading strategies to prevent, detect, and address fraud, waste, abuse, and improper payments; overseeing nationwide provider oversight and enforcement activities; coordinating audits, investigations, and corrective actions with Federal and State agencies, State Medicaid Fraud Control Units (MFCUs), and law enforcement partners; and achieving measurable results that improved program integrity, strengthened accountability, or reduced improper payments across the country.
TQ 2: Demonstrated executive-level experience integrating program integrity into enterprise strategy, policy development, and national operational frameworks for Medicaid, the Children's Health Insurance Program (CHIP), or comparable Federal health care programs. This includes identifying gaps in statutory, regulatory, or policy frameworks; developing and implementing policy, regulatory, or operational solutions to address emerging risks and program vulnerabilities; aligning program integrity initiatives with agency-wide strategic planning, budget priorities, and legislative proposals; and advising senior leadership on program integrity strategy, risk management, and national policy direction.
EXECUTIVE CORE QUALIFICATIONS (ECQs): In addition to the Technical Qualification Requirements listed above, all new entrants into the Senior Executive Service (SES) under a career appointment will be assessed for executive competency against the following five mandatory ECQs. If your 2-page resume does not reflect demonstrated evidence of the ECQs and TQs, you may not receive further consideration for the position.
There are five ECQs:

• ECQ 1: Commitment to the Rule of Law and the Principles of the American Founding - This core qualification requires a demonstrated knowledge of the American system of government, commitment to uphold the Constitution and the rule of law, and commitment to serve the American people.
• ECQ 2: Driving Efficiency - This core qualification involves the demonstrated ability to strategically and efficiently manage resources, budget effectively, cut wasteful spending, and pursue efficiency through process and technological upgrades.
• ECQ 3: Merit and Competence - This core qualification involves the demonstrated knowledge, ability and technical competence to effectively and reliably produce work that is of exceptional quality.
• ECQ 4: Leading People - This core qualification involves the demonstrated ability to lead and inspire a group toward meeting the organization's vision, mission, and goals, and to drive a high-performance, high-accountability culture. This includes, when necessary, the ability to lead people through change and to hold individuals accountable.
• ECQ 5: Achieving Results - This core qualification involves the demonstrated ability to achieve both individual and organizational results, and to align results to stated goals from superiors.

Note: If you are a member of the SES or have been certified through successful participation in an OPM-approved SES Candidate Development Program (SESCDP) or have SES reinstatement eligibility, you do not need to respond to the ECQs. Instead, you should attach proof (e.g., SF-50, Certification by OPM's SES Qualifications Review Board (QRB)) of your eligibility for noncompetitive appointment to the SES.
Education
This job does not have an education qualification requirement.
Additional information
Veterans' Preference: Veterans' preference is not applicable to the SES.
Mobility:Organizational and geographical mobility is essential in developing and managing SES leaders. Individuals selected for SES positions may be subject to reassignment across geographical, organizational, and functional lines, and may be required to sign a Reassignment Rights and Obligation Agreement.
Equal Employment Opportunity (EEO) Policy Statement: http://www.eeoc.gov/federal/index.cfm
Employment Information Resources - Resource Center: https://help.usajobs.gov/how-to
Males born after 12-31-1959 must be registered or exempt from Selective Service (see https://www.sss.gov/RegVer/wfRegistration.aspx)
OPM must authorize any employment offers made to current or former (within the last 5 years) political Schedule A, Schedule C, or Non-career SES employees in the executive branch. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C, or Noncareer SES employee in the executive branch, you must disclose that to the Human Resources Office.
Salary for SES positions varies depending on qualifications. The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments.
This position is designated as a Testing Designated Position (TDP). You must successfully complete a pre-employment urinalysis drug screening. You will be subject to unannounced random drug testing for the duration of service in this position.
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.
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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.
Benefits
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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.
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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.