Private Sector Payer and Insurance Subject Matter Expert

Private Sector Payer and Insurance Subject Matter Expert Position Summary Cetechs is seeking a Subject Matter Expert (SME) for Private Sector Payer and Insurance.

The Subject Matter Expert (SME) provides specialized executive guidance on strategy and program development related to private sector payer and insurance matters.

This role serves as a federal health systems adviser, focusing on the advancement of value-based care pilots, community care alignment, and legislative reporting in compliance.

Key Responsibilities Advise on the design and implementation of value-based care models and pilots, with emphasis on community care integration and accountable care organization models  Support the development of legislative reports, strategy documents, and recommendations for both VHA and community care providers.

Analyze and report on cost realization, clinical outcomes, and operational alignment across diverse care domains, including but not limited to primary care and polytrauma care.

Develop strategies to bridge care coordination between VHA and external community care partners, particularly in rural health contexts.

Guide the assessment and implementation of complex care delivery solutions in federal and commercial health systems, ensuring best practices across varied environments.

Required Qualifications Master’s degree in a healthcare, business, or related field.

At least 10 years of executive and advisory experience spanning federal and commercial health systems, including work with rural health and complex care environments.

Minimum of 20 years’ progressive healthcare operations experience with demonstrated expertise in system transformation and clinical domain analytics.

Preferred Qualifications Doctorate with board certification in a clinical specialty.

Demonstrated executive leadership experience within large or multifaceted healthcare organizations.

Prior involvement in analysis, implementation, or reporting of programs driven by major legislative acts (e.g., the Senator Elizabeth Dole Act)..

Skills & Competencies Deep knowledge of payer systems, value-based care, and accountable care organization structures.

Outstanding analytical, strategy, communication, and stakeholder management skills.

Proven ability to operate at an executive level across federal, commercial, and rural healthcare settings.

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