Nurse (Payment Policies and Programs)

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Hospital & Ambulatory Policy Group (HAPG), Division of Outpatient Care (DOC).

As a Nurse (Payment Policies and Programs), GS-0610-13, you will provide clinical practice advice, formulate policies, and assess the integrity and quality of clinical aspects that influence CMS-administered healthcare financing programs.

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.

In order to qualify for the GS-13 grade level, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Providing clinically informed input into policy recommendations related to Medicare payment; AND 2) Analyzing data from healthcare payment systems, for example, Prospective Payment Systems (PPS), related to provider billing and operations; AND 3) Providing clinical nursing or program guidance on the application of payment provisions.

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. Major Duties:

• Develop, evaluate, and interpret national health care payment policies related to Medicare, providing clinically informed recommendations regarding payment systems or nursing practice implications.
• Conduct complex policy analyses and program evaluations, such as analysis of Medicare Prospective Payment Systems (PPS).
• Provide expert clinical consultation and technical guidance to CMS leadership, contractors, and external stakeholders on clinical policy issues, healthcare delivery trends, and regulatory implementation.
• Prepare high-level policy documents and communications, including regulatory text, briefing materials, manuals, and operational guidance related to CMS programs.
• Plan and conduct meetings with other CMS components and external partners and organizations and contribute to discussions and planning sessions on program policy developments.