Remote Provider Network Development Jobs in West Virginia

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Professional Engineering

Job Qualifications:

Skills:

Healthcare Operations, Performance Improvements, Quality Management

Certifications:

None

Experience:

3 + years of related experience

US Citizenship Required:

No

Job Description:

GDIT is seeking Healthcare Performance & Improvement Lead to support a new Third Party Administrator (TPA) contract by directing quality assurance, performance monitoring, and continuous operational improvement activities. In this role, you will own GDIT's TPA operational quality oversight function - ensuring performance standards are met, monitored, and reported in accordance with our contractual requirements.

This position will lead recurring compliance and performance assessments, track administrative and clinical trends affecting member health and continuity of care, and drive continuous improvement initiatives aligned with the Program's strategic goals. Through disciplined monitoring, documentation, and audit readiness, you will help ensure the Program consistently meets federal performance expectations and supports high-quality outcomes for its members and stakeholders.

Responsibilities:

• Serve as the GDIT's primary owner of Quality Assurance (QA) activities while ensuring all contract tasks are performed accurately, consistently, and on time.

• Maintain working mastery of functional and system Acceptable Quality Levels (AQLs), including what is monitored, how monitoring occurs, evaluation methodology, documentation practices, and reporting cadence.

• Coordinate fulfillment of ad hoc information requests from the Program related to performance oversight, audits, or formal reviews, ensuring responses are accurate and delivered on Program-determined timelines.

• Lead regular assessments of Contractor compliance and performance, covering:

  • Compliance with contract requirements, performance standards, and acceptable quality levels.

  • Administrative and clinical trends affecting member health, continuity of care, and stakeholder experience.

  • Alignment with healthcare industry standards and best practices from other federal payers.

• Translate assessment findings into actionable, continuous, proactive improvement initiatives aligned with Program strategic goals and priorities.

• Partner with cross-functional teams (claims, enrollment, clinical, provider network, care coordination) to ensure quality findings inform operational practice.

Required Skills:

• Bachelor's degree with 3+ years of experience in quality management, performance oversight, or compliance roles supporting federal healthcare programs, health plans, or TPAs.

• Strong understanding of healthcare operations, including claims adjudication, enrollment, certification, provider networks, and care coordination.

• Consulting experience in identification and implementation of improvement initiatives with functional teams and business users.

• Experience working within federally regulated environments and supporting programs with high visibility and strict oversight requirements.

• Demonstrated ability to design and lead compliance assessments, trend analysis, and continuous improvement programs.

• Ability to leverage data analysis and reporting tools such as Power BI & Excel to track performance trends and improvement outcomes.

• Strong written and verbal communication skills for stakeholder-facing reporting and audit liaison work.

Preferred Qualifications:

• Experience supporting CDC, CMS, or other federal and/or commercial health programs.

• Experience supporting quality assurance and management during contractor transitions, system implementations, or large operational transformations.

.

GDIT IS YOUR PLACE:

• Full-flex work week to own your priorities at work and at home.

• 401K with company match.

• Comprehensive health and wellness packages.

• Internal mobility team dedicated to helping you own your career.

• Professional growth opportunities including paid education and certifications.

• Cutting-edge technology you can learn from.

• Rest and recharge with paid vacation and holidays.

#GDITFedHealthJobs

The likely salary range for this position is $112,840 - $115,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee's date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.Join our Talent Community to stay up to date on our career opportunities and events at

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans