Sr. Subject Matter Expert â Health Plan Strategist
Sr. Subject Matter Expert â Health Plan Strategist
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Job Description
Position: Sr. Subject Matter Expert Health Plan Strategist
Location: Falls Church VA
Work Environment: Onsite
Clearance Required: NACI
Status: Contingent
Knowesis is currently seeking an exceptional Senior Subject Matter Expert (SME) Health Plan Strategist with an expert understanding of the Defense Health Agencys TRICARE Health Plan to join our team and provide invaluable support to the Defense Health Agency (DHA) Health Care Operations division.
To be eligible for this position candidates must have or have the ability to obtain a NACI clearance and possess U.S. Citizenship without the need for sponsorship both now and in the future. Applicants without proof of U.S. Citizenship will not be considered due to the positions security clearance requirements.
The Senior Subject Matter Expert Health Plan Strategist will provide expert guidance and strategic oversight to DHA in the design implementation and evaluation of health plan strategies within the TRICARE Health Plan (THP). The SME will be responsible for analyzing health care policies developing actionable strategies to optimize health plan operations and ensuring that TRICARE health benefits align with DHAs mission and the needs of military beneficiaries. The Senior Subject Matter Expert Health Plan Strategist will strategically inform health plan execution and support the Government representative in key meetings and external engagements providing high-level expertise to shape decision-making and enhance operational effectiveness.
The Job Duties and Responsibilities include but are not limited to the following:
Strategic Health Plan Design and Oversight:
- Lead the development and execution of strategic plans for the TRICARE Health Plan aligning with DHAs objectives and military health care priorities.
- Advise senior leadership on health plan policies benefits and operational strategies to optimize care delivery for military personnel and their families.
- Provide recommendations to improve TRICARE health care systems policies and processes ensuring alignment with federal regulations and military-specific needs.
Policy Analysis and Development:
- Analyze existing health care policies and propose changes to enhance the effectiveness of TRICARE health benefits.
- Stay up-to-date with evolving healthcare regulations including TRICARE federal and state policy changes and advise DHA leadership on their impact on health plan operations.
- Develop new policies and guidelines related to health plan management and reimbursement ensuring they are actionable practical and aligned with DHA goals.
Health Plan Performance Evaluation:
- Collaborate with analytical teams to evaluate the performance of the TRICARE Health Plan identifying key metrics and performance indicators to assess care quality beneficiary satisfaction and operational efficiency.
- Use performance data and analytics to inform health plan strategy and policy recommendations with a focus on improving outcomes and reducing costs.
- Lead efforts to identify and resolve gaps in health plan service delivery including working with stakeholders to design and implement corrective actions.
Stakeholder Engagement and Collaboration:
- Strategically inform health plan execution and support the Government representative in key meetings and external engagements ensuring alignment with DHAs strategic goals.
- Work closely with DHA leadership policy teams operational units and external partners (e.g. Managed Care Support Contractors health providers) to ensure the successful implementation of health plan strategies.
- Provide subject matter expertise during meetings with senior government officials external stakeholders and contractors to inform decision-making and ensure alignment with DHA health care goals.
- Drive continuous improvement efforts evaluating existing systems and recommending changes to enhance efficiency care quality and beneficiary satisfaction within the TRICARE Health Plan.
- Oversee risk management strategies ensuring that health plan operations meet high standards of quality and compliance.
Executive Communication & Reporting Assistance:
- Develop and present executive-level reports briefings and presentations for DHA leadership providing clear actionable insights and recommendations related to TRICARE health plan strategies.
- Communicate complex healthcare policy and strategic information to a variety of audiences including government officials DHA staff and external stakeholders
Required Qualifications:
- Bachelors degree in Health Administration Public Health Business Administration or a related field. A Masters degree in a relevant field is preferred.
- At least 10 years of experience in healthcare policy health plan management or health systems operations with a focus on military health care or public health systems.
- Extensive experience working within or alongside the Defense Health Agency (DHA) TRICARE Health Plan (THP) or similar healthcare delivery systems.
Skills & Expertise:
- Deep knowledge of TRICARE Health Plan operations military healthcare systems and federal healthcare regulations.
- Proven ability to develop and implement health plan strategies that improve care delivery efficiency and beneficiary satisfaction.
- Strong expertise in policy analysis healthcare reimbursement models and performance management.
- Exceptional analytical problem-solving and decision-making skills with the ability to translate data into actionable insights.
- Experience in leading cross-functional teams and managing complex multi-faceted health plan initiatives.
- Excellent communication skills with the ability to present complex ideas clearly to senior leadership and external stakeholders.
- Strong leadership abilities with a proven track record of driving health care strategy and operational excellence.
- Ability to manage complex projects and multi-disciplinary teams with competing priorities and deadlines.
- Highly adaptive with the ability to thrive in a fast-paced and dynamic healthcare environment.
- Commitment to continuous learning and staying up-to-date on the latest trends and best practices in health plan management.
Benefits:
- Health (PPO & HDHP) Insurance Dental Vision STD & LTD Basic Life Insurance 401k Company Match & Voluntary Products.
Knowesis is committed to providing equal employment opportunities to all individuals based on merit and qualifications. We prohibit discrimination in all aspects of employment as required by Title VII of the Civil Rights Act and other applicable federal laws. Our company values all applicants and employees and fosters a work environment where everyone is treated with respect and dignity.
Required Experience:
Senior IC
Employment Type
Full-Time
