Nurse

About the Agency Learn more about working at CMS. Visit our CMS LinkedIn Careers page to hear from leadership and explore our hiring priorities: https://www.linkedin.com/company/centers-for-medicare-&-medicaid-services/life/a8009813-3bf5-4d64-bd6f-ca176c2c0a97 About the Role READY TO USE YOUR CLINICAL EXPERTISE TO PROTECT MEDICARE? Join the Center for Program Integrity as a Nurse providing authoritative clinical guidance to teams interpreting laws, regulations, and policies for complex healthcare issues. At CMS, you'll bring your nursing knowledge to program integrity work—helping prevent improper payments and safeguard Medicare for the beneficiaries who depend on it. Your clinical judgment could protect Medicare's integrity for millions. Are you ready to get started? Responsibilities Conduct in-depth research on the background and origin of laws, regulations, and policies and their impact on healthcare programsWork with CMS components on data interpretation, recovery audits, claims processing, medical review, and appeals to ensure accurate clinical Medicare policy implementationSupport cross-functional teams on projects impacting program integrity operationsParticipate in and lead analytical studies to evaluate policy effectiveness using clinical and program dataServe as a CMS point of contact for beneficiaries, providers, suppliers, professional associations, congressional offices, and contractors Qualifications Current, active, unrestricted RN license from a State, DC, Puerto Rico, or US territoryPassed the National Council Licensure Examination (NCLEX)Degree from an accredited professional nursing programExperience in clinical policy, program integrity, or claims/payment review (specifics vary by grade level)Grade Levels: GS-0610-11/12 (3 vacancies) — career ladder to GS-12Note: This role may require travel (25% or less) Required Skills Resume and transcripts required (2 page resume limit). Apply through USAJOBS by September 15, 2026. Pay range and compensation package Salary: $85,447 - $133,142/year (varies by grade) Equal Opportunity Statement #Nursing #ProgramIntegrity #RN #Medicare #ClinicalPolicy #FraudPrevention #FederalJobs #CMS