Program Specialist
What you'd do
The primary purpose of this position is to serve as an integral link between the local Office of Community Care and our network Community Providers. The work requires the position to gather and analyze data; conduct face to face, telephonic and electronic communications; collaborations and training to ensure the operating program meets the intent and initiatives of the Care in the Community (CITC) program(s).
Major duties
Program Administration Analyzes and evaluates using both qualitative and quantitative principles working in collaboration with both regional and other medical center community provider specialists to improve the experience of Community Providers associated in providing services to Veterans and support to local VAMC veterans' health care delivery experience. Supports operations in meeting established goals, metrics and objectives. Using regional office guidelines and policy, implements and modifies program policies, regulations, goals, or objectives. Identifies data required for use in the management and direction of programs. Develops program evaluation plans, procedures, and methodology. Works with Office of Community Care (OCC) Regional Program Office to evaluate programs against short and long-range objectives. Develops and maintains positive relationships with local medical center Community Providers and stakeholders, such as hospital associations and affiliates. Provides ongoing education, partners with the OCC and Community Care Network (CCN) Regional staff and serves as a customer service point of contact for problem resolution regarding claims, provider network adequacy, access to care issues, standards of quality health care delivery, and contract relationships. This position works positively and collaboratively with the OCC Provider Relations Office, VISN and VACO representatives to resolve and escalate concerns stemming from community and VA providers. This position will establish regular points of contacts with community hospitals, community specialty and primary care practices and performs regular and reoccurring visits on a scheduled basis to provide education and address concerns. At least 50 percent of the time will be spent traveling and meeting with community provider stakeholders. Investigates and resolves problems and special cases brought to the attention of top management including those from the agency's executive management staff. Gathers facts and resolves conflicts of information or interpretation and develops cases in accordance with applicable policies, procedural manuals, and other guidelines, and coordinates resolution development appropriate operating offices. Monitors trends in provider issues and reports to the Service Chief. Monitors appeals for providers within the assigned region. Communicates quality issues to providers and Quality, Safety, Value (QSV) staff through the chief of Community Care position and helps create action plans to improve quality metrics; remains in contact with provider throughout process. Direction/Long-Range Planning Supports the development of a program for the continued growth in use of data analytics and decision support based on these analytics including: identification of resources available for analysis, identification of gaps in services, identification of data quality, and issues that impact management ability to make informed decisions based on key data metrics associated with these data sets. Provides and assists with establishing and participating in monitoring tools and performance metrics to evaluate Network Capacity (access), community referral processes, provider relationships, and other performance and compliance factors. Analyzes trends for a range of initiatives (e.g: network adequacy, provider complaints, credentialing compliance, referral processing) compared on a National level, identifying markets, where deficiencies or irregularities are identified which may need further investigation to determine anomalies between sites. Recommends corrective action for optimal efficiency within the department and interrelated programs. Makes formal and informal presentations outlining the history, status, and objectives of all functional responsibilities. Quality/Productivity In collaboration with VISN leadership and VACO Regional Community Provider Specialist (CCN) works collaboratively to implement future CCN priorities/programs and help to develop and promote network adequacy in support of local medical center. Develops, maintains, and executes tasks related to project management necessary for the assessment and analysis of projects. Develops complex business strategies that include current Community programs, associated systems and future initiatives. Responsible for managing and integrating the work of assigned teams from different organizations for successful execution of all projects. Ensures that the skills, tools, and people are in place to meet the customer needs for the projects to be executed. Work Schedule: Monday - Friday; 7am-330pm; 730am-4pm; or 8am-430pm Virtual: This is not a virtual position. Position Description/PD#: Program Specialist/PD013530 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized
What you need to qualify
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 08/26/2026. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-09 position you must have served 52 weeks at the GS-07. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: knowledge of a wide range of qualitative and/or quantitative methods for the assessment and improvement of program effectiveness, contract document review, and analysis of billing and claims processing methodologies in a healthcare or managed care environment, knowledge of agency program goals and objectives including the sequence of timing of key program events and milestones and methods of evaluating the work of program accomplishments, knowledge of the range of terminology, special and general reimbursement methodologies used in managed care contracting, knowledge of agency program goals and objectives including the sequence of timing of key program events and milestones and methods of evaluating the work of program accomplishments, knowledge of, and skill in applying, a wide range of methods used to gather, analyze, and evaluate information concerning management processes, drawing conclusions, and recommending appropriate actions, knowledge of relational databases and related software necessary to independently produce reports and documents for management information in a timely and accurate fashion. Ability to correlate and analyze copious amounts of narrative and statistical material to address appropriate actions concerning policies, changes of program direction, and manpower and resource utilization. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a master's or equivalent graduate degree or two full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education as described above. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
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