Deputy Administrator and Director, Center for Program Integrity

Full Job Description

This position is located in the Center for Program Integrity (CPI), Centers for Medicare and Medicaid Services (CMS).

As the Deputy Administrator and Director, Center for Program Integrity, you will provide executive leadership, direction, and oversight of CMS's program integrity efforts by proactively identifying, predicting, and preventing waste, fraud, and program abuse through advanced analytics, artificial intelligence, real-time monitoring, and emerging technologies.

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: Program Integrity Leadership in Healthcare Programs: Demonstrated executive-level experience leading large-scale program integrity efforts within complex healthcare programs, such as Medicare, Medicaid, Children's Health Insurance Program (CHIP), or the Health Insurance Exchanges, including designing and implementing comprehensive strategies to prevent, detect, and address fraud, waste, and abuse; applying risk-based approaches to identify and mitigate program vulnerabilities; leading and coordinating audits, investigations, and corrective actions across multiple stakeholders (e.g., federal and state agencies, contractors, and law enforcement); and delivering measurable results that improved program integrity, accountability, or reduced improper payments.

TQ 2: Data, Analytics, and Emerging Technologies: Demonstrated executive-level experience leveraging data, analytics, and emerging technologies to strengthen program integrity or enterprise risk management, including applying predictive modeling, anomaly detection, or other advanced analytical methods; using data to identify risks, detect vulnerabilities, and inform strategic decision making; integrating analytics into program integrity operations, including audits and investigations; and leading the adoption or expansion of data-driven and technology-enabled solutions to improve performance and outcomes.

TQ 3: Enterprise Risk Management, Strategy, and Policy Integration: Demonstrated executive-level experience integrating program integrity or risk management into enterprise strategy, policy development, and operational decision making, including identifying gaps in statutory, regulatory, or policy frameworks and assessing emerging risks; developing and implementing policy, regulatory, or operational solutions; aligning program integrity or risk management efforts with organizational priorities and mission objectives; and advising and influencing senior leadership on enterprise risk and strategic 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. Major Duties:

• Provides executive leadership and direction in the development and implementation of the Medicare and Medicaid Integrity Programs and provides strategic direction for CMS, the states, and law enforcement partners.
• Develops and implements innovative approaches to address emerging fraud schemes including pilot projects, demonstrations and other mechanisms aimed at improving the detection and prevention of fraud prior to claim payment.
• Manages oversight of all program integrity contractors, ensuring accountability, appropriate adoption of innovative tools and approaches, and effective data sharing across contractors and partners.
• Serves as the principal advisor to the Administrator and Chief Operating Officer of CMS, on all program integrity activities related to CMS's programs.
• Promotes the principles of quality management, such as teamwork, customer focus, employee involvement and continuous improvement in carrying out responsibilities.
• Directs the development of proposed legislative, regulatory, and policy changes to assist states in identifying and preventing fraud and abuse and promoting consistency in fraud and abuse standards.