Sr. TB Benefit and Membership Integration Advisor – PhilHealth, DOS LEAP Global – Philippines

Who We Are ZemiTek, LLC is a Woman-Owned, SBA-certified 8(a) Small Disadvantaged Business (SDB) based in the Washington, DC metro area. We have a strong record delivering innovative and high-quality solutions. Since 2007, ZemiTek has provided technical assistance, project management, information technology (IT), knowledge management, monitoring and evaluation, training and learning development, and institutional support services. Position Description Global Solutions Ventures (GSV) – a joint-venture partnership between ZemiTek, LLC and Dexis Consulting Group – is implementing the Long-term Exceptional Technical Assistance Project (LEAP Global), a mechanism originally used by USAID to battle against infectious diseases such as malaria, HIV/AIDS, tuberculosis, neglected tropical diseases, and pandemic influenza. As of July 1, 2025, LEAP Global transitioned to the U.S. Department of State (DOS). This initiative aims to address the complex human resource challenges faced by national infectious disease programs in the USA-supported countries. The intervention of this project is to hire and embed technical expert advisors and subject matter experts within government entities. By directly embedding the technical expertise within the national programs, LEAP provides long-term, sustainable lifesaving support to empower host governments to lead and manage key aspects of their infectious disease portfolios and improve coordination between the U.S. Government and the host country. About the Position The TB Benefit and Membership Integration Advisor – PhilHealth will support the Philippine Health Insurance Corporation (PhilHealth) in strengthening the end-to-end membership journey, with a focus on translating membership into effective access, navigation, and utilization of health services particularly for TB clients who are eligible to avail of the PhilHealth TB DOTS package. While PhilHealth has made significant progress in expanding coverage, key gaps remain in ensuring that members are able to seamlessly access and utilize benefits across the continuum of care. These challenges include fragmented service delivery pathways, limited visibility of patient movement across systems, and inefficiencies in provider workflows and claims processes. Anchored within the Member Management Group (MMG), the Advisor will focus on bridging membership platforms with service delivery, provider engagement, and benefit utilization, ensuring that membership results in actual service use and improved health outcomes.  The Advisor will support the Department of Health in carrying out life-saving humanitarian assistance (LHA) service delivery in full alignment with the new Presidential Executive Order (EO) directives.  The engagement will use the TB DOTS benefit package as a tracer program to: Map and analyze the full membership-to-care journey Identify systemic bottlenecks affecting access and utilization Design and test solutions that can be scaled across other benefit packages and conditions Embedded within PhilHealth and working closely with MMG, Operations, IMS, and other relevant units, the Advisor will support a delivery-oriented, iterative process to strengthen systems, policies, and digital tools that enable effective member access and utilization. Work Location: Philippines Responsibilities The TB Benefit and Membership Integration Advisor will: 1. Initial Preparatory Work Conduct a rapid desk review of existing PhilHealth policies, circulars, guidelines, and technical reports related to membership, primary care (YAKAP), and selected benefit packages. Review available data on membership, service utilization, and claims patterns. Map existing systems and processes that support the membership journey and service delivery. Develop a detailed work plan, including priority workstreams, timelines, and key milestones. Agree with PhilHealth on governance arrangements, coordination mechanisms, and validation processes. 2. Membership Journey Mapping (End-to-End) Map the end-to-end membership journey, including: Registration to the NHIP Assignment/empanelment to providers under YAKAP First Patient Encounter (FPE) and initial service access Navigation across services (diagnosis, treatment, follow-up) Claims processing and benefit utilization Use TB DOTS as a tracer condition to ground the analysis in a real-world care pathway. Identify key friction points, drop-offs, and inefficiencies affecting member access and continuity of care. Assess how digital tools and systems support or hinder this journey. 3. Data Analytics and Utilization Review Analyze data across membership, service delivery, and claims to understand: Conversion from membership to actual utilization Drop-offs across the care continuum Variations in performance across regions, providers, and member segments Use TB DOTS data to generate deeper insights into patient pathways and outcomes. Support development of dashboards or tracking tools to monitor membership-to-utilization performance. 4. Stakeholder Consultations and Coordination Facilitate consultations with: PhilHealth units (MMG, Operations, IMS, FMS, Corporate Planning) Selected providers and field units (PROs/LHIOs) Development partners and technical stakeholders Validate findings and co-develop solutions with implementers. Document agreements, action points, and recommendations. 5. Solution Design and Integration with YAKAP Co-develop solutions to strengthen the membership-to-care continuum, including: Improving navigation from enrollment to service access Enhancing provider engagement and accountability Strengthening continuity of care within empaneled providers Use TB DOTS as a testing ground for interventions, such as: Integration of screening and care pathways within FPE Strengthening referral and follow-up systems Ensure alignment with YAKAP design, including empanelment, primary care