Clarification from the agency

Open to all groups of qualified individuals from the public, including current employees within the Federal Excepted Service, current employees within the Federal Competitive Service, current Career SES, and SES reinstatement eligibles. SESCDP graduates may also apply for noncompetitive consideration.

• 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.

Conditions of employment

• Must be a U.S. Citizen or National.
• Subject to a 1-year supervisory probationary period (unless already completed).
• Complete a Declaration for Federal Employment to determine your suitability for Federal employment, at the time requested by the agency.
• If you are a male applicant born after December 31, 1959, certify that you have registered with the Selective Service System or are exempt from having to do so.
• May be subject to pre-employment verification.
• You may be required to obtain and maintain an interim and/or final security clearance prior to entrance on duty. Failure to obtain and maintain the required level of clearance may result in the withdrawal of a job offer or removal.
• The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, OGE-278e, prior to assuming the SES position, annually, and upon termination of employment.
• Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
• All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
• Only experience obtained by the closing date of this announcement will be considered.

Qualifications

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.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

You will be evaluated on the quality and extent of your total accomplishments, experience, and education (if applicable). Your application will be rated and ranked by a Senior Executive Service (SES) Panel, comprised of at least three SES members, using only the information required within the application package. Applicants who do not demonstrate in their application sufficient possession of the ECQs and TQs will be determined ineligible for further consideration.

Once the application process is complete, a review of your resume and supporting documentation will be conducted. If you meet minimum qualifications, your Application Package will be further reviewed to determine if you possess the Executive Core Qualifications (ECQ) and Technical Qualifications (TQ) listed above. ECQs and TQs must be thoroughly addressed within your two (2) page resume. Separate narratives will not be accepted or reviewed. Highly Qualified applicants may undergo one or more interviews and may be referred to the selecting official for further consideration.

Upon selection, if not already a member of the SES serving under a career appointment, the individual selected must have his/her executive qualifications certified by the U.S. Office of Personnel Management's SES Qualifications Review Board (QRB) before appointment to this position. The selected individual's application will be forwarded to the OPM for review and certification by the QRB, unless the selectee provides evidence of their noncompetitive status (i.e., a current SES, OPM QRB certified SESCDP graduate, or SES reinstatement eligible). Upon QRB certification, the selected individual will be required to serve a one-year probationary period. For more information regarding the SES, go to https://www.opm.gov/policy-data-oversight/senior-executive-service/.

A complete application includes items described below. Please note that if you do not provide all required information, as specified in this announcement, you may not be considered for this position (or may not receive the special consideration for which you may be eligible).

Please carefully review the following list to determine what documentation you need to submit. Some documents may not apply to all applicants.

1. RESUME: All applicants are required to submit a resume limited to two (2) pages (i.e., 1 page that is double-sided or 2 pages that are one-sided each) showing all relevant experience. Applicants seeking initial career appointment to the Senior Executive Service (SES) must include evidence of the ECQs and TQs. PLEASE DO NOT USE USAJOBS RESUME BUILDER.

2. VACANCY QUESTION/ASSESSMENT QUESTIONNAIRE RESPONSES: Responses are automatically submitted through USA Jobs when you apply to this vacancy. Click the following link to preview the assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12931744.

3. ADDITIONAL REQUIRED DOCUMENTS: Applicants are required to submit the following supporting documentation if applicable:

• CURRENT OR FORMER SES MEMBERS: Must provide your SES appointment SF-50 (Notification of Personnel Action), and an SF-50 showing current career SES status or career SES reinstatement eligibility.
• SES CANDIDATE DEVELOPMENT PROGRAM (SESCDP) GRADUATES: Verification of successful completion of an OPM-approved SESCDP and OPM SES QRB certification.
• CURRENT FEDERAL CIVIL SERVICE EMPLOYEE: Must provide a copy of your Notification of Personnel Action, Standard Form 50 (SF-50) or equivalent personnel action form reflecting you are a current Federal Civil Service employee.

• Noncriminal Justice Applicant's Privacy Rights, for those who undergo an FBI fingerprint-based criminal history record check for personnel vetting, which includes Rap Back,
• FD-258 Privacy Act Statement - FBI (this is the same statement used when your fingerprints are submitted as part of your background investigation), and
• SEAD-3-Reporting-U.pdf (dni.gov), (applicable to those who hold a sensitive position or have eligibility for access to classified information)"

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