Senior Healthcare Quality Consultant – Medicare

This is a fully remote position, open to applicants in Washington.

📋 Description

• Provide strategic advice to Medicare Advantage organizations regarding Star Ratings, quality enhancement, and operational efficiency.

• Lead consulting projects concentrated on CAHPS, HOS, and the overall member experience.

• Evaluate performance factors and create as well as implement targeted strategies and interventions for improvement.

• Convert measure performance and regulatory updates into operational priorities and actionable plans for enhancement.

• Collaborate with quality, member experience, clinical operations, provider engagement, pharmacy, customer service, analytics, and executive leadership teams.

• Establish governance frameworks, workplans, performance monitoring systems, and accountability measures.

• Integrate quantitative analysis with operational insights to pinpoint practical improvement opportunities.

• Offer subject matter expertise to Milliman's research, analytics, and thought leadership initiatives.

• Assist in expanding Milliman’s Medicare quality and Star Ratings consulting capabilities, service offerings, and client solutions.

• Provide mentorship to consultants through informal guidance and sharing of knowledge.

• Engage in business development by identifying opportunities and contributing to client proposals.

⛳️ Requirements

• A Bachelor’s degree is mandatory.

• Over 7 years of experience in healthcare quality, Medicare Advantage, health plan operations, or a related field.

• Extensive experience focused on Medicare Advantage Star Ratings.

• Proven track record in developing and implementing quality improvement strategies and interventions.

• Significant experience with HEDIS, CAHPS, and HOS performance improvement initiatives.

• Understanding of the operational factors that influence quality outcomes and methods to enhance performance.

• Strong analytical skills with the capability to convert data into actionable insights.

• Self-motivated and capable of operating independently as a senior, client-facing advisor.

• Willingness to mentor junior staff and informally share expertise.

• Interest in expanding the practice through new and enhanced client relationships.

• Ability to clearly and practically communicate complex quality and regulatory matters.

• Legally authorized to work in the United States without the need for immigration support or sponsorship.

• Preferred: experience representing an organization at industry conferences and professional events.

• Preferred: advanced degree in healthcare administration, public health, business administration, health policy, nursing, or a related discipline.

• Preferred: experience in developing new consulting services or establishing a Medicare quality or Star Ratings practice.

• Preferred: experience in both a Medicare Advantage health plan and a healthcare consulting/advisory setting.

• Preferred: experience contributing to healthcare quality research and industry publications.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees, dependents, and domestic partners.

• Employee Assistance Program (EAP).

• 401(k) plan featuring company matching and profit-sharing.

• Discretionary Bonus Program.

• Flexible Spending Accounts (FSA).

• Paid Time Off (PTO).

• A minimum of 10 paid holidays annually.

• Family Building Benefits, including adoption and fertility assistance.

• Up to 11 weeks of paid parental leave for eligible employees.

• Life Insurance and AD&D with full coverage of premiums.

• Fully funded short-term and long-term disability.

• Opportunities for skills training and career development.

• Access to learning and mentoring programs.

• Participation in Employee Resource Groups (ERGs).