Consultant, Medicare Stars – Regulatory Performance Improvement

This is a fully remote position, open to applicants in California, +3 more states.

📋 Description

• Lead consulting projects aimed at enhancing Medicare Stars and improving regulatory performance.

• Analyze and interpret data related to HEDIS, CAHPS, HOS, Part D, operational metrics, and Special Needs Plans (SNPs).

• Conduct performance evaluations, trend analysis, gap assessments, cut-point modeling, and root cause investigations.

• Formulate executive-level recommendations and actionable strategies for improvement based on data insights.

• Collaborate with health plan and medical group stakeholders to identify opportunities for quality, experience, and operational enhancements.

• Design and facilitate workshops, training sessions, and initiatives for process improvement.

• Oversee project plans, timelines, deliverables, budgets, and engagement results.

• Cultivate client relationships and act as the primary contact throughout the consulting engagements.

• Keep abreast of CMS guidelines, regulatory requirements, and updates to technical specifications, translating these changes into client recommendations.

• Work alongside cross-functional teams to integrate Stars consulting strategies with analytics, CAHPS, HOS, and member experience solutions.

• Provide consulting assistance across HEDIS, CAHPS, HOS, Part D, and SNPs.

• Guide clients in navigating CMS and state requirements using readiness assessments, simulations, and strategic planning.

• Support M&A integrations, organizational restructuring, and SNP launches through governance design, stakeholder alignment, quality program optimization, and performance improvement strategies.

⛳️ Requirements

• A minimum of 2 years of experience in health plan quality, Medicare Stars, healthcare consulting, experience management, or performance improvement.

• Hands-on experience in supporting Dual/SNP and MA Star Ratings performance.

• Knowledge of one or more quality domains, including HEDIS, CAHPS, HOS, Part D, medication adherence, or quality operations.

• Strong analytical and problem-solving abilities, with proficiency in tools such as Excel, Access, SQL, SAS, or similar software.

• Proven track record in driving measurable quality or performance improvement initiatives.

• Excellent written, verbal, and presentation communication skills.

• Capability to influence stakeholders and communicate effectively with executive audiences.

• Advanced proficiency in Microsoft Office Suite, especially Excel and PowerPoint.

• Strong project management and organizational abilities.

• Bachelor's degree is required.

• Must be located in the U.S.

🏝️ Benefits

• Competitive benefits package.

• Discretionary bonus or commission based on achieved results.

• Remote work options available for U.S.-based employees.

• Reasonable accommodations for qualified individuals with disabilities or disabled veterans.