Senior Program Analyst, Federal Health

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🔥 20 minutes ago

🌵 Arizona, Colorado, +24 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $130k - $160k / year

⏰ Full Time

🟠 Senior

📋 Program Manager

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Commence

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🏛️ Government

🤖 Artificial Intelligence

Healthcare • Government • Artificial Intelligence

Commence is a healthcare data and technology company that delivers data-centered solutions to make health data more accessible, discoverable, and interoperable. The company pairs clinical expertise with AI-driven data transformation and a technology platform to address fraud, waste & abuse, independent dispute resolution, peer and independent reviews, quality improvement, and patient advocacy. Commence serves federal health agencies (CMS, VA, Defense Health Agency), state & local government programs, and commercial health customers, focusing on improving outcomes, accuracy, and program integrity.

📋 Description

• Serve as a subject matter expert (SME) in VA disability benefits adjudication and federal program analysis • Translate deep regulatory knowledge of VA disability rating criteria into structured business logic for AI model training and validation • Evaluate evidence sufficiency across VA disability claims • Support federal program delivery activities • Define and operationalize the regulatory and evidentiary definition of Ready for Decision (RFD) across targeted VA disability condition types • Produce a condition-by-condition RFD Criteria Reference Guide mapping evidentiary requirements to 38 CFR Parts 3 and 4 and M21-1 adjudication standards • Review and validate AI-generated determinations against the claim file or synthesized data; assess accuracy, reasoning quality, and correct identification of missing or incomplete development • Review AI-compiled medical records and generated assessments for completeness and validity against applicable rating criteria • Translate VA rating knowledge into structured business logic suitable for AI model training and workflow validation • Maintain a running Edge Case Log documenting claim scenarios where AI determinations are incorrect or incomplete, with specific regulatory citations • Provide ad hoc SME consultation on condition-specific standards, regulatory updates, and claims development pathways throughout program delivery.

🎯 Requirements

• Minimum 2 years of direct compensation claim rating experience as a VBA Rating Veteran Service Representative (RVSR) • Broad familiarity across high-volume VA disability condition types and prior experience as a subject matter expert, trainer, or quality reviewer in a VA program context • Expert-level knowledge of 38 CFR Part 3 (Adjudication) and Part 4 (Schedule for Rating Disabilities) • Working knowledge of M21-1 adjudication procedures, including evidentiary sufficiency standards and Ready for Decision (RFD) criteria • Ability to assess the sufficiency of private medical records (PMR), service treatment records (STR), C&P exam reports, nexus opinions, buddy statements, VA Form 201 (personnel file) • Ability to translate complex regulatory knowledge into clear written deliverables — including analytical memos, criteria documentation, and structured feedback — suitable for technology development teams and senior executive audiences • Ability to obtain and maintain a VA Public Trust clearance.

🏖️ Benefits

• Reasonable accommodations for individuals with disabilities • Equal employment opportunity policies