Nurse

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Data Analytics & Systems Group. As a Nurse, GS-0610-13, you will provide clinical/nursing guidance for CMS policy teams handling difficult or sensitive issues in Medicare/Medicaid programs, and a contact for questions from beneficiaries, providers, contractors, and others about clinical concerns and ways to protect CMS programs. Responsibilities Apply a wide range of software, systems, and analytical platforms to identify overpayments and detect fraud/abuse across Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Develop algorithms/models, conducting data mining, and providing clinical and analytical decision support to improve the efficiency and effectiveness of program integrity operations. Review Federal laws, regulations, and procedural guidelines to advise leadership on technical flaws and reg...