Sr. Subject Matter Expert – Health Plan Strategist

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 Agency’s 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 position’s 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 DHA’s 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 DHA's 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 DHA’s 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