Sr. Consultant - Commercial Healthcare Expert Security Clearance

Sr. Consultant - Commercial Healthcare Expert with Security Clearance Tria Federal Seven Corners, VA, United States
** Description
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* Who we are:

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians. For two decades, federal agencies have relied on Tria companies to advance their critical missions and modernize their systems, so that they can uphold their commitment to the American people. Today, we are pushing the boundaries of possibility through partnerships and investments in artificial intelligence and emerging technologies, developing solutions for the biggest challenges that government will face tomorrow.

We are proud to employ and support military veterans who bring mission-first mindset, technical expertise, and leadership qualities that strengthen our work. Veterans, transitioning service members, and military spouses are strongly encouraged to apply. Tria Federal is seeking a Senior Consultant – Commercial Healthcare & Managed Care SME to support the Department of Veterans Affairs. The SME will provide senior-level healthcare industry and managed-care expertise to help VA assess, monitor, and improve health-plan operations, provider network performance, clinical quality, reimbursement, access, and care delivery across the community-care environment.

The ideal candidate brings substantial experience in commercial health plans, managed care, payer/provider operations, clinical quality, population health, network performance, value-based care, and healthcare transformation. The candidate will translate industry practices into practical recommendations for the VA environment while recognizing the unique requirements of Government health-plan operations. Responsibilities:  
* Provide subject matter expertise on commercial healthcare and managed-care operating models, payer/provider relationships, network performance, access, quality, and healthcare delivery.  
* Analyze current-state health-plan and community-care operations and identify gaps, risks, inefficiencies, and opportunities for improvement.  
* Assess provider network performance, access, capacity, quality, utilization, and member/patient experience.  
* Provide expertise on managed-care models, provider engagement, value-based care, alternative payment models, and healthcare cost/outcome management.  
* Evaluate clinical quality programs, quality measures, performance trends, and opportunities to improve healthcare outcomes.  
* Support development of business cases, assessments, white papers, strategic analyses, and executive recommendations.  
* Translate commercial health-plan and industry practices into recommendations applicable to Government healthcare operations.  
* Collaborate with providers, clinical leaders, acquisition teams, contracts personnel, data/analytics teams, and other SMEs.  
* Review and provide SME input to policies, procedures, requirements, performance measures, governance materials, and operational guidance.  
* Support acquisition, implementation, and operationalization activities involving health-plan and provider-network requirements.  
* Develop executive briefings, decision papers, risk analyses, and recommendations for senior VA leadership.

Skills & Experience:

* 8+ years of progressively responsible healthcare, health-plan, consulting, or managed-care experience.  
* Demonstrated experience within a commercial health plan, managed-care organization, payer, provider organization, or healthcare consulting environment.  
* Strong understanding of managed-care operations and payer/provider relationships.  
* Experience with clinical quality, healthcare performance improvement, or population-health initiatives.  
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