Nurse

This position is within the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Provider Compliance Group (PCG). As a Nurse, GS-0610-11/12, you will provide authoritative clinical and nursing advice and guidance as part of CMS program policy or support teams responsible for interpreting applicable laws, regulations, and policies for complex, controversial or sensitive issues in CMS-administered program.

Major duties

• Conducts in-depth research on the background and origin of laws, regulations, and policies, and their intended impact on healthcare programs.
• Works with various CMS components on data interpretation, recovery audits, claims processing and payment, medical review, and appeals to ensure consistent and accurate implementation of clinical Medicare policy.
• Supports cross-functional and cross-organizational teams on projects and initiatives that impact program integrity operations.
• Participates in and leads analytical studies to evaluate the effectiveness of policies by gathering, organizing, and interpreting clinical and program data.
• Serves as a CMS point of contact for beneficiaries, providers, suppliers, professional associations, congressional offices, and contractors.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume (limited to no more than 2 pages) 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. Applicants must demonstrate that they meet the Basic Requirements as noted below. Education: A graduate or higher-level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained; OR a Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Licensure: For all grade levels and positions, 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. Exemption: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector, to include: 1.Assisting in identifying program vulnerabilities and proposing changes in procedures regarding clinical, policy, or operational issues. 2.Supporting the creation of clinical policies aimed at preventing or minimizing improper payments for services or items provided to Medicare beneficiaries. AND 3.Contributing to discussions on management program policy developments. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1.Producing clinically informed recommendations to senior policy analysts related to assigned program integrity programs. 2.Supporting cross-organizational teams on projects and initiatives that impact program integrity operations. 3.Evaluating claims payments necessary to administer national health insurance programs. AND 4.Developing responses to inquiries regarding program integrity to a variety of internal and external stakeholders. Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying. 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

Education Requirement: In addition to meeting the qualification requirements, all candidates must have the following educational requirements: A graduate or higher-level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained; OR a Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Licensure: For all grade levels and positions, 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. Exemption: Employees currently assigned to positions in this occupational series as of September 2017 will be considered to have met the basic requirements for the position occupied. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see "Required Documents" section below for what documentation is required at the time of application. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13053370