Sr. Consultant - Commercial Healthcare Expert

 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.


• 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.

Why Tria?
What defines the Tria brand is more than just our dedication to excellence in our craft; it’s our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team’s shared success.

As a company that cares about people, we seek to cultivate a culture in which all can thrive personally and professionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at work and in life. At Tria, we are growth-minded, entrepreneurial in spirit, and committed to fostering a culture of inclusion and opportunity for all. Whatever your background, your role, your department, or stage in your professional journey, here you will have opportunities to learn new skills, seize new challenges, and advance your career as we grow. 

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