Performance Improvement Program Manager, GS-340-15
U.S. Office of Personnel Management
July 26, 2018
Full Time - Experienced
This position is located in the Performance Improvement Group within the Federal Employees Insurance Operations, which is located in the Healthcare and Insurance Division of the Office of Personnel Management.
The Program Manager of the Performance Improvement Group will plan, direct, and oversee operations of the Federal Employees Health Benefits (FEHB) Plan Performance Assessment (PPA) and performance improvement projects, including managing activities associated with curation of the measure set, data collection, calculation and validation of the scores. In addition, this position oversees incorporation of results into overall performance scoring and the functions listed below with respective staff.
If selected, you will perform the following duties:
Perform selection and maintenance of measures evaluated in the PPA, including prioritization, weighting, benchmark selection, scoring, and analysis of results across the portfolio of FEHB plans.
Conduct annual plan preview for all FEHB carriers to validate or dispute scoring before final results are applied to allowable plan payment formulas.
Identify new measures as well as measures requiring update or retirement.
Monitor the PPA to assess the need for changes in the measure set or methodology, as well as detecting individual and systematic elements of noncompliance by carriers.
Draft, compile, and approve internal and external program documents, including but not limited to PPA Carrier Letters, Operations Manual, Methodology Manual, reports, white papers, and trend analyses.
Prepare professional presentations and training modules for key stakeholders, including FEHB Carriers and OPM staff.
Conduct internal audit, reconciliation, and controls pertaining to the PPA.
****You MUST complete the initial online assessment and USAHire Assessment as part of the application process. https://www.usajobs.gov/GetJob/ViewDetails/506140200
For the GS 15: You must have at least one year of specialized experience that is equivalent in difficulty and complexity to the GS-14 level in the Federal service that is directly related to timely, efficient, precise, and effective performance accountability for health plan quality and includes all of the following:
Comprehensive Knowledge of the health benefits and insurance Industry as evidenced by previous positions in the industry or in a government agency that administers health insurance programs.
Oversight of planning, development, implementation, and execution of a healthcare quality/ performance improvement program as evidenced by relevant prior positions and/or certification as a health care quality professional (Certified Professional in Healthcare Quality, Certified Professional in Healthcare Risk Management, Certified Utilization Management/Credentialing Review, or similar). This could also be evidenced by participation on performance or quality-related committees such as the NCQA's (National Committee on Quality Assurance) Committee on Performance Measurement, URAC Standards Committee, or a National Quality Foundation (NQF) committee.
Development of performance assessments, measure specifications, or methodology for a healthcare performance improvement program as indicated by prior positions at a health plan, health system, healthcare quality organization, or government agency performing related work.
Evaluation of program quality, customer service, and resource use/cost in any healthcare, insurance, or business setting.
Application of project planning and/or project management techniques to establish priorities, coordinate assignments, and forecast program direction, including budget and staff resources. This may include, but does not require, formal project management training. This requirement can be satisfied with a detailed description of prior project and supervisory responsibilities.
You must meet all qualification and eligibility requirements by the closing date of this announcement. 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.
(NOTE: THIS JOB IS OPEN UNTIL AUGUST 15, 2018. YOU MUST COMPLETE THE APPLICATION SUBMISSION BY THAT DATE.)
Telecommuting is allowed.
Internal Number: 18-371-JLW-DE
About U.S. Office of Personnel Management
Pharmaceutical Program Manager position is located within Healthcare and Insurance and has primary responsibility for the oversight of pharmacy programs, formularies, pharmacy quality initiatives, and coordination of pharmacy benefits for the Federal Employees Health Benefits (FEHB) Program and the Multi-State Plan Program (MSPP).
The Healthcare and Insurance (HI) group provides for a comprehensive package of health benefits under the Federal Employees Health Benefits (FEHB) Program for employees, retirees, and their dependents by managing a broad array of health plans under contract to OPM. Benefits include comprehensive prescription drug programs usually offered through Pharmacy Benefit Managers (PBM) under contract to the health plans. HI also manages the Affordable Care Act's Multi-State Plan Program, through which Multi-State Plan options are offered on the Exchanges in over 30 states. HI supports customers' health insurance decisions with health plan brochures, a Guide to Federal benefits, Website postings and Web-based comparison/decision tools, health plan customer satisfaction survey results, and qualitative outcome measures from the Healthcare Effectiveness Data and Information Set (HEDIS).