Program Manager
Who may apply
Limited to the following applicant groups:
- Veterans
- Individuals with disabilities
- Military spouses
- Federal employees - Competitive service
- Career transition (CTAP, ICTAP, RPL)
- Land and base management
Washington, District of Columbia
Last day to apply
Salary: $169,279 – $197,200
per year
(GS-15)
Salary context
Based on 128 annual-salary jobs in the same occupational series. This role pays above most similar positions.
Job Details
Position Overview
As a Program Manager, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will lead administrative program integrity operations that safeguard Federal health benefits programs by directing carrier compliance reviews, audit resolution, fraud prevention and detection activities, payment integrity oversight, corrective-action monitoring, contract-remedy support, and a multidisciplinary workforce while collaborating with government and industry partners.Duties
- Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits programs.
- Lead oversight of administrative reviews by evaluating program documentation, audit findings, referral information, claims and payment data, and other relevant materials to recommend corrective actions, recoveries, disallowances, sanctions-implementation steps, or other administrative remedy options.
- Oversee health insurance carriers' compliance with contractual and regulatory requirements by directing carrier compliance reviews, validating corrective actions, and resolving program integrity findings through appropriate administrative processes.
- Analyze program integrity trends, claims data, audit results, carrier submissions, and risk indicators to identify vulnerabilities, improper payment risks, control weaknesses, and opportunities to strengthen fraud prevention and detection efforts.
- Coordinate administrative review, referral, corrective-action, compliance, and contract-remedy activities with Offices of Inspector General, legal counsel, contracting officials, program offices, carriers, health care organizations, and other oversight partners.
- Develop policies, procedures, documentation standards, referral protocols, corrective-action processes, and performance measures that improve health insurance program integrity, accountability, and administrative oversight.
- Supervise a multidisciplinary workforce responsible for administrative program integrity reviews, carrier compliance oversight, audit resolution, payment integrity, corrective-action monitoring, referral coordination, and contract-remedy support.
Qualifications & Requirements
For the GS 15: You must have one full year (52 weeks) of specialized experience comparable in scope and responsibility to the GS-14 grade level or pay band in the Federal service (obtained in either the public or private sectors) performing ALL of the following:- Providing administrative program integrity analysis and recommendations to address potential fraud, waste, abuse, improper payment risk, program vulnerabilities, or noncompliance involving public or private health insurance programs;
- Coordinating administrative review, referral, corrective-action, compliance, or contract-remedy activities with oversight organizations, legal counsel, contracting officials, health care organizations, carriers, program offices, or other stakeholders;
- Analyzing supporting documentation, audit findings, medical claims, billing data, financial records, carrier submissions, or other program information to identify potential Fraud, Waste, Abuse patterns, improper payment risks, control weaknesses, root causes, and options for administrative corrective action or contract remedies;
- Preparing referral packages, issue summaries, corrective-action recommendations, recovery or disallowance analyses, sanctions-implementation reviews, contract-remedy options, or other administrative review products supported by program integrity findings and appropriate documentation; AND
- Developing policies, procedures, documentation standards, referral protocols, and performance measures that support the prevention, detection, administrative review, referral coordination, corrective action, and resolution of fraud, waste, abuse, improper payment risk, and material control weaknesses in health insurance programs.
Merit promotion applicants must meet the time-in-grade requirement as defined in 5 CFR 300, Subpart F. One year at the GS-14 grade level is required to meet the time-in-grade requirements for the GS15 level.
You must meet all qualification and eligibility requirements within 30 days of 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.
Requirements
- Must be a U.S. Citizen or National
- 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 not eligible for inclusion in a bargaining unit
Evaluations
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 to 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):Accountability, Developing Others, Interpersonal Skills, and Strategic Thinking
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.
All qualified Non-Competitive applicants and the best-qualified Merit Promotion applicants will be referred to the hiring manager for 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 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.
Required Documents
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
- Other supporting documents:
- Cover Letter, optional
- Most recent Performance Appraisal, optional
- Your most recent Promotion, Within Rate Increase (WRI/WGI), or Appointment/Conversion SF-50 or Notification of Personnel Action if applying as a current or former Federal / OPM Employee showing you are/were in the competitive service and the highest grade or promotion potential held, required if applying as a current or former Federal / OPM employee.
- Worker's Compensation Separation: Agency certification of inability to place employee AND Notification of Separation OR Separation SF-50.
- Disability Annuity Termination: Notification from OPM of disability annuity termination AND Separation SF-50 of the last position held.
- Military Reserve or National Guard Technician Special Disability Retirement Annuity under 5 U.S.C. 8337(h) or 8456: Certification of special disability retirement annuity from a military department or National Guard Bureau AND Separation SF-50 of the last position held.
- Veterans Employment Opportunity Act, Veterans Recruitment Appointment, and 30% Disabled Veteran Eligible: DD-214, SF-15 Form and VA letter, or certification of expected discharge or release from active duty under honorable conditions within 120 days.
- Schedule A, Persons with Disabilities Appointment Eligibles: Schedule A letter from a physician, local, state, or federal rehabilitation office citing your eligibility under 5 CFR 213.3102 (u).
- Certain Family Members Eligible under E.O. 12721: Your most recent non-award SF-50 and performance appraisal.
- Certain Military Spouses Eligible under E.O. 13832: Permanent Change of Station (PCS) orders; OR verification of the member's 100% disability (VA Letter); and/or verification of the member's death while on active duty (DD-1300 and Death Certificate) AND verification of the marriage to the service member (i.e., a marriage license or other legal documentation verifying marriage).
- Interchange Agreement with Other Merit Systems Eligible: Documentation of eligibility as listed in each interchange agreement.
- Career Transition Assistance Program/Interagency Career Transition Assistance Program 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.)
How to Apply
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.
For more general information, system requirements, reasonable accommodation information, and to request assistance regarding the USA Hire Assessments, review the following resources: https://help.usastaffing.gov/Apply/index.php?title=USA_Hire_Assessments
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.
You may preview the assessment questionnaire by clicking here: https://apply.usastaffing.gov/ViewQuestionnaire/13023803 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.
Once referred, you may be asked to complete a structured interview, written demonstration, and/or final 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.
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.
Generally, 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. However, there are exceptions to this rule for positions, such as the one covered by this vacancy announcement, for which the hiring agency is required to make a criminal history inquiry before extending an offer. Accordingly, we may ask about your criminal history for this position before making a conditional job offer. We may ask you to provide or authorize us to collect your criminal history information. We will give you more details on these inquiries, including providing any required release of information form(s).
Source: Data sourced from USAJOBS