Job Description

We are seeking experienced and knowledgeable US Healthcare Subject Matter Experts (SMEs) to provide consulting services across various domains, including government healthcare programs, pharmacy benefit management, claims processing, care management, specialty pharmacy operations, home care services, and public sector healthcare initiatives.

As a SME, you will leverage your expertise to guide clients in regulatory compliance, operational optimization, strategic development, and implementation of healthcare policies and programs. Your ability to analyze trends, deliver actionable insights, and ensure adherence to industry standards will be crucial in driving client success.

Key Responsibilities:

Provide expert guidance and consulting services in your area of expertise.

Assist clients with regulatory compliance, risk mitigation, and operational efficiency.

Develop and optimize strategies to enhance program outcomes and align with industry standards.

Deliver training sessions and develop resources for stakeholders and staff.

Analyze data and trends to provide actionable insights and recommendations.

Support clients with program implementation, process improvements, and technology adoption.

Stay updated on industry regulations, policies, and emerging trends.

• Areas of Expertise We Are Looking For:
• Government Programs (Medicare, Medicaid, ACA, FEP):
  
  

Extensive knowledge of CMS and OPM regulations, managed care, and HEDIS measures.

Experience in compliance strategy, risk management, and data analysis.

• Pharmacy Benefit Management (PBM):
  
  

Expertise in formulary management, drug utilization review, and PBM operations.

Familiarity with pharmaceutical industry dynamics and healthcare regulations.

• Claims, Enrollment, and Provider/Pricing:
  
  

In-depth understanding of claims processing, provider credentialing, and reimbursement models.

Proficiency in HIPAA transaction standards and EDI systems.

• Care Management:
  
  

Experience in utilization management, chronic disease management, and telehealth.

Knowledge of population health management and value-based care models.

• Specialty Rx and Pharmacy:
  
  

Strong background in specialty drug management, patient adherence programs, and REMS compliance.

Expertise in biosimilars, limited distribution models, and hub services.

• Home Care Services:
  
  

Deep understanding of home health and hospice regulations, EVV systems, and telehealth.

Experience in optimizing scheduling, routing, and quality measures (e.g., OASIS).

• Public Sector Healthcare:
  
  

Extensive experience in public health policy, Medicaid expansion, and healthcare funding mechanisms.

Knowledge of HIEs, interoperability standards, and emergency preparedness.

Preferred Qualifications:

Certifications such as CHC, AHIP, CRCR, CPHRM, CCM, ACM, PharmD, BCPS, CHPN, or CPH.

Advanced degrees in Public Health, Health Policy, or related fields.

Exceptional communication, analytical, and problem-solving skills.

Engagement Type:

This is a freelance/consulting opportunity with flexible hours and project-based assignments. You will work closely with clients to address their unique needs and provide tailored solutions.

• How to Apply:
  
  

Please submit your resume along with a proposal in your area of specialization.

• IMPORTANT NOTE:
  
  

For US Freelancers: You must be authorized to work as an independent contractor (1099).

For Indian Freelancers: Please ensure you have no conflicts of interest or agreements with your current employer or client that would prevent you from accepting this project. (**Please keep your proposed rate within the standards of the Indian market)