Job Summary

Senior Program Review Specialist

 

Aptive is seeking a Senior Program Review Specialist to support a federal health program involving structured review of applications, submissions, or case documentation. The role will evaluate materials for eligibility, policy alignment, completeness, consistency, and evidentiary support and will develop clear, well-documented recommendations for government consideration.

 

The Senior Program Review Specialist will also help establish reviewer guidance, promote consistent application of program criteria, support resolution of complex cases, and improve review quality through calibration and continuous feedback.

The ideal candidate brings strong policy interpretation, analytical judgment, and documentation-review experience and can translate complex requirements into practical, repeatable review criteria.

Primary Responsibilities

• Lead end-to-end reviews of applications, submissions, or case files using approved policies, procedures, templates, and evaluation criteria.
• Assess eligibility, program alignment, documentation completeness, internal consistency, and the credibility of supporting evidence.
• Prepare clear review records documenting evidence considered, findings, unresolved issues, and the basis for recommendations.
• Develop and maintain standardized review checklists, decision trees, evidence matrices and reviewer job aids.
• Identify missing, unclear or inconsistent information and coordinate targeted clarification requests through the applicant communications function.
• Ensure review conclusions are traceable to the governing requirement and distinguish factual findings from professional judgment or recommendation.
• Conduct secondary reviews of complex, sensitive, or borderline cases and elevate interpretive questions through established channels.
• Lead reviewer calibration sessions to improve consistency, reduce rework, and document relevant guidance or precedents.
• Analyze recurring deficiencies and recommend updates to intake instructions, templates, SOPs and quality controls.
• Protect applicant information and maintain accurate records in the designated document repository and tracking system.

Minimum Qualifications

• Bachelor’s degree in public policy, healthcare administration, business administration, social sciences, law, compliance or a related field.
• Minimum of 5 years of experience performing technical, eligibility, compliance, policy or documentation reviews.
• Demonstrated ability to interpret statutes, regulations, policies or program requirements and apply them consistently to individual cases.
• Experience assessing evidence, documenting findings and developing defensible written recommendations.
• Exceptional attention to detail and ability to identify gaps, inconsistencies and unsupported claims in submitted materials.
• Strong writing skills and ability to communicate review findings clearly to technical and non-technical audiences.
• Ability to manage a steady volume of assignments while meeting turnaround and quality expectations.
• Legal authorization to work in the U.S.

Desired Qualifications

• Experience supporting VA, another federal health agency, Veterans’ programs, healthcare navigation, public benefits, or community-partnership initiatives.
• Experience reviewing nonprofit, volunteer, community-based, healthcare, or public-service organizations.
• Experience with credentialing, certification, eligibility, licensing, grants, claims, or other formal application-review processes.
• Experience developing review rubrics, checklists, standard work or knowledge-management resources.
• Familiarity with Lean methods, reviewer calibration and root-cause analysis.