Health Insurance Specialist

4 days ago


Chicago, Illinois, United States Centers for Medicare and Medicaid Services Full time
Job Summary

We are seeking a highly skilled Health Insurance Specialist to join our team at the Centers for Medicare and Medicaid Services. As a key member of our team, you will be responsible for providing expert technical guidance on Medicaid Managed Care policies and programs.

Key Responsibilities
  • Provide technical expertise on Medicaid Managed Care policies and programs for federal and state health care plans.
  • Draft health policy statements, guidelines, and procedural instructions to implement healthcare initiatives.
  • Advise and collaborate with various stakeholders for policy development, implementation, and program improvement.
  • Conduct program-related studies and data analysis regarding quality of care, program oversight, utilization of program services by beneficiaries, or program payments.
  • Interpret the intent of statutes to produce federal regulations, policy statements, and other program guidance for Medicaid Managed Care for federal and state health plans.
Requirements

To be eligible for this position, you must have at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government. Your resume must demonstrate your experience in providing expert technical guidance, drafting health policy statements, and advising stakeholders.

Qualifications

As a Health Insurance Specialist, you will be responsible for ensuring that state and Medicaid managed care plans are operating in compliance with all Federal rules and requirements. You will also be responsible for reviewing Managed care plan network adequacy data to ensure that Medicaid managed care plan networks can provide timely access to care for all Medicaid services and benefits.

Additional Information

This is a bargaining unit position with the American Federation of Government Employees Local 1923. The tour of duty is flexible, and the recruitment/relocation incentive is not authorized. The financial disclosure is required.



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