Director Audits and Vulnerabilities Group

Full Job Description

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

As the Director Audits and Vulnerabilities Group, you will provide crucial leadership and executive direction in program integrity functions across all CMS programs, including Medicare (Fee-For-Service (FFS), Part C, Part D), Medicaid, the Children's Health Insurance Program (CHIP), and the Marketplace.

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 knowledge and experience developing and implementing strategies to combat waste, fraud, and abuse in Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.

This includes knowledge of the laws, regulations, and policies governing the administration of health care delivery and program integrity, as well as the ability to apply performance metrics and analytical tools to evaluate and improve program effectiveness, management processes, and systems in support of organizational priorities.

TQ 2: Demonstrated experience in a senior-level leadership role engaging and negotiating with senior officials across government agencies, law enforcement organizations, and public and private sector partners on complex and controversial issues related to health care programs, including protecting and strengthening program integrity.

Demonstrates a proven ability at the executive level to build collaborative partnerships and lead cross-agency efforts to address complex, high-visibility policy and operational challenges.

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:

• Serves as the primary focal point for collaboration with senior executives within CMS in the preparation of short, intermediate, and long-range plans for the improvement of CMS programs and policies.
• Formulates and implements expert strategies to address vulnerabilities that foster improper payments, fraud, waste, or abuse in Medicare, Medicaid, CHIP, and Marketplace programs.
• Collaborates with CMS and partner agencies to advise and coordinate policies, regulations, and programs focused on identifying, resolving, and preventing vulnerabilities and related program integrity issues.
• Formulates and implements expert strategies to address vulnerabilities that foster improper payments, fraud, waste, or abuse in Medicare, Medicaid, CHIP, and Marketplace programs.
• Oversees the Vulnerability Tracking and Prioritization process for the Center, including the intake, analysis, and disposition of vulnerabilities and associated cross-center and cross-agency collaboration.