Positions at CMS
Health Insurance Specialists develop, interpret and implement health care financing policy and affect the disbursement of billions of dollars each year. Among other things, they also analyze Medicare and Medicaid policies, identify trends in health care utilization, study the private health insurance industry, and participate in inspections and program evaluations.
Information Technology Specialists design and implement computer systems which aid research efforts, policy development and employee performance. They often work with other Federal and State Government agencies and outside organizations to coordinate the Medicare and Medicaid computer systems. Information technology specialists also program and analyze improvements in systems' applications.
Social Science Research Analysts conduct research and test new policies and processes designed to improve program operation.
Management Analysts focus on CMS's internal operations with the goal of improving organizational effectiveness. In particular, they focus on the administrative feasibility and implementation of laws, regulations, and policies. In doing so, Management Analysts design information systems; institute productivity improvements; provide advice on organizational structure and work methods; and prevent fraud, waste, and abuse.
Economists at CMS research and interpret economic data related to CMS programs. They also help design, implement, and evaluate Medicare and Medicaid demonstrations as well as related quality assurance projects.
Actuaries use mathematics and statistics to analyze and provide cost estimates concerning the financing of Medicare, Medicaid, and related modifications to these programs.
Health Insurance Specialists monitor and evaluate state Medicaid programs for compliance with Federal regulations. Staff provides advice about the law, regulations, and policy in such issue areas as eligibility, coverage and payment. They also monitor and evaluate the work of organizations that contract with Medicare. These employees strive to ensure compliance with provisions of the contract, the law and Federal regulations.
Survey and Certification Specialists offer technical assistance to State certification agencies. This assistance relates to Medicare and Medicaid activities that affect the delivery of health care. Survey and certification specialists also review and assess the quality of health care delivered by Medicare and Medicaid providers. Among the health professionals in this specialty are nurses, medical technologists, dieticians, and pharmacists.
Nurse Consultants review, analyze and evaluate the effectiveness and quality of services delivered by Medicare and Medicaid providers.
Medical Technologists conduct reviews of laboratories for Federal monitoring and laboratory certification purposes. They also provide technical assistance to State certification agencies.
Managed Care Specialists coordinate, implement and monitor overall operations of managed care health plans (i.e., Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans), and Federally qualified Health Maintenance Organizations. They ensure that the health care program results in an appropriate and adequate level of medical service delivery to Medicare enrollees. These responsibilities include performing functions related to the qualification and compliance of Medicare contracting and Federally qualified managed health care plans with the requirements of Federal laws, regulations and other mandated guidelines.
In addition to these headquarters and regional office positions, CMS's success also depends on the abilities and contributions of others such as:
- Financial Management Specialists
- Budget Analysts
- Medical Officers
- Public Affairs Specialists
- Video and Graphics Production Specialists