Senior Consultant - Commercial Healthcare Expert (Managed Care)

Location: Remote

Company

hirify.global delivers digital services and technology solutions for federal agencies supporting the health and safety of veterans, service members, and civilians.

What you will do

• Provide senior-level expertise on commercial healthcare, managed-care operating models, payer-provider relationships, network performance, access, quality, and care delivery.
• Analyze health-plan and community-care operations to identify gaps, risks, inefficiencies, and improvement opportunities.
• Assess provider network capacity, quality, utilization, patient experience, clinical quality programs, and performance trends.
• Evaluate value-based care, alternative payment models, provider engagement, cost management, and healthcare outcomes.
• Develop business cases, strategic analyses, white papers, risk analyses, executive briefings, and decision papers for senior VA leadership.
• Collaborate with providers, clinical leaders, acquisition and contracts personnel, data and analytics teams, and other subject-matter experts.

Requirements

• 8+ years of progressively responsible healthcare, health-plan, consulting, or managed-care experience.
• Experience in a commercial health plan, managed-care organization, payer or provider organization, or healthcare consulting environment.
• Strong understanding of managed-care operations, payer-provider relationships, healthcare performance, cost, quality, access, or utilization analysis.
• Experience with clinical quality, healthcare performance improvement, or population-health initiatives.
• Strong executive communication, facilitation, and written-product development skills.
• Bachelor’s degree required; a relevant master’s degree is preferred.

Nice to have

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

Culture & Benefits

• Benefits package supporting physical, mental, and financial health and wellness.
• Growth-minded and entrepreneurial working environment.
• Commitment to inclusion, opportunity, professional learning, and career development.
• Veterans, transitioning service members, and military spouses are strongly encouraged to apply.