Lead VBC Quality Consultant

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Act as the strategic quality advisor for a designated portfolio of Value-Based Care organizations.

• Evaluate performance and pinpoint opportunities across Medicare Stars, HEDIS, CAHPS, medication adherence, clinical quality, member experience, and VBC quality objectives.

• Oversee approximately 8–10 VBC organizations as the primary national quality liaison for assigned accounts.

• Set annual, quarterly, and monthly quality priorities in alignment with contract objectives, performance trends, population demands, and performance risks.

• Create partner-specific quality strategies, action plans, milestones, and accountability frameworks.

• Supervise implementation, intervene when progress deviates, evaluate intervention effectiveness, and suggest necessary adjustments.

• Assess provider-, measure-, and member-level data to recognize performance drivers, care-gap opportunities, emerging risks, and variations among markets or provider groups.

• Convert findings into initiatives that enhance gap closure, medication adherence, preventive care, chronic condition management, and member experience.

• Disseminate scalable best practices throughout the VBC portfolio.

• Assist with performance forecasting, executive reporting, and prioritization of high-impact measures and populations.

• Collaborate with Market Quality, Network, Provider Engagement, Analytics, Pharmacy, Risk Adjustment, Clinical Operations, Data/EMR teams, and leadership.

• Lead or participate in cross-functional workgroups that address performance obstacles, data challenges, provider workflow requirements, and enterprise quality goals.

• Convey provider insights and ongoing barriers to internal teams to guide national strategy, resource distribution, and process enhancements.

• Execute other assigned responsibilities and adhere to all policies and standards.

⛳️ Requirements

• Bachelor's Degree in Nursing, Public Health, Healthcare Administration, Business Administration, or a related field, or equivalent relevant experience.

• At least 5 years of experience in Medicare quality improvement, Medicare Stars, HEDIS, population health, or a closely related area.

• Proven experience in analyzing healthcare performance data and transforming findings into actionable strategies.

• Strong understanding of CMS Medicare Stars and NCQA HEDIS criteria and performance improvement methodologies.

• Experience in interpreting and applying clinical data analytics and outcomes measurement in the healthcare sector.

• Proficiency in using Excel, Power BI, and PowerPoint.

• Preferred experience in leading external stakeholder meetings and independently managing multiple complex accounts or initiatives.

• Current or prior RN, LPN/LVN, PA, PharmD, or other relevant clinical licensure is preferred; a clinical background is highly valued but not mandatory.

🏝️ Benefits

• Competitive salary.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• Comprehensive benefits package, subject to program eligibility.