Sr. Consultant - Commercial Healthcare Expert

About the Role

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.
• Experience analyzing healthcare operations, performance, cost, quality, access, or utilization.
• Demonstrated ability to translate industry practices into practical business recommendations.
• Strong executive communication, facilitation, and written-product development skills.
• Bachelor's degree required; Master's degree in Healthcare Administration, Public Health, Business, Nursing, Clinical/Health Sciences, or related field preferred.

Qualifications

• Medicare Advantage, Medicaid, commercial insurance, or dual-eligible experience.
• Provider network management or network adequacy.
• Value-based care / alternative payment models.
• HEDIS, CAHPS, Stars, NCQA, URAC, CMS quality programs, or similar.
• Population health management.
• Provider contracting or payer/provider strategy.
• VA/VHA/IVC/CCN experience.
• PMP, Lean Six Sigma, CPHQ, CPC, or similar.

Benefits

Tria offers a top-tier benefits package to invest in your physical, mental, and financial health and wellness. The company fosters a culture of inclusion and opportunity with opportunities to learn new skills, seize new challenges, and advance your career.