Health Plan Functions Consultant, Mid in Washington, DC at Booz Allen Hamilton Inc.

Date Posted: 9/10/2018

Job Snapshot

Job Description

Job Number: R0035869

Health Plan Functions Consultant, Mid

Key Role:
Work across an array of health-focused government organizations, including the Department of Veterans Affairs (VA), DoD, and Health and Human Services (HHS) to provide insight and develop and implement health plan and insurance-based services. Administer health plan functions, including provider network contracting and reimbursement, revenue and expense modeling, claims processing and analysis, care management and usage practices, medical policy development and review, provider and customer relations and services, product design, member and provider communications, rate build-ups, auditing and fraud detection, and population health analytics and reporting. Identify best practice approaches to address cost, quality, and member experience. Work on delivery teams and with clients to develop, model, or implement health plan functions using best practices from the commercial health plan industry. Produce deliverables and provide consultative input and facilitation to help a client meet its mission relative to health care coverage. Develop and deploy cost, quality, or member experience solutions. 

Basic Qualifications:
-5+ years of experience with health plans, including managing health plan functions in commercial or government sectors
-3+ years of experience in project management, including working with teams to define, plan, and manage complex scope and IT systems from start to finish and keeping projects on schedule and within budget and resource constraints while mitigating risks
-Experience in collaborating with others to produce both high-level and detailed requirements
-Knowledge of cost, quality, or customer experience solutions
-Knowledge of healthcare data analysis
-Knowledge of health plan products and services
-Ability to comprehend and master health plan topics quickly
-BA or BS degree

Additional Qualifications:                                                               
-Experience with Medicare Advantage and Medicaid Plans, TriCare, or VA Community Care a plus
-Knowledge of the requirements needed to deliver, build or deploy a health plan function successfully
-Knowledge of the basic functions of a health plan and how they relate and impact stakeholders
-Ability to work well independently within a fast-paced, team-oriented environment
-Ability to discuss population health models and approaches a plus
-Possession of excellent oral and written communication skills
-MA or MS degree

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