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Consultant (Medicare Stars & Regulatory Performance Improvement)
90 000 - 125 000$
Job description
Text:
TL;DR
Consultant (Medicare Stars & Regulatory Performance Improvement) (Medicare Advantage, HEDIS, CAHPS, HOS, Part D, and SNPs): Improving health plan quality performance through data analysis, regulatory readiness, and performance transformation with an accent on Star Ratings, quality-gap analysis, and CMS requirements. Focus on modeling measure cut points, identifying root causes, advising executive stakeholders, and managing complex consulting engagements.
Location: Remote, U.S.-based
Travel: Up to 50%
Salary: $90,000–$125,000 base annually, plus a discretionary bonus or commission and benefits.
Company
provides experience measurement, data analytics, and advisory expertise to help organizations improve human experiences, with roots in U.S. healthcare.
What you will do
- Lead consulting engagements focused on Medicare Stars and regulatory performance improvement.
- Analyze HEDIS, CAHPS, HOS, Part D, operational-measure, and SNP performance data.
- Conduct performance assessments, measure trending, gap analyses, cut-point modeling, and root-cause analyses.
- Develop executive recommendations and actionable strategies to improve quality, member experience, and operational performance.
- Design and facilitate workshops, training sessions, and process-improvement initiatives.
- Manage project plans, timelines, budgets, deliverables, client relationships, and engagement outcomes.
Requirements
- 2+ years of experience in health plan quality, Medicare Stars, healthcare consulting, experience management, or performance improvement.
- Hands-on experience supporting Dual/SNP and Medicare Advantage Star Ratings performance.
- Knowledge of one or more of HEDIS, CAHPS, HOS, Part D, medication adherence, or quality operations.
- Experience using Excel, Access, SQL, SAS, or similar analytical tools; advanced proficiency in Microsoft Office, especially Excel and PowerPoint.
- Strong analytical, problem-solving, presentation, communication, project management, and organizational skills.
- Bachelor's degree required.
Nice to have
- Experience with M&A integrations, organizational restructuring, or SNP launches.
- Experience translating CMS guidance, regulatory requirements, and technical specification updates into client recommendations.
Culture & Benefits
- Work with health plans and medical groups on programs serving Medicare beneficiaries.
- Collaborate with cross-functional teams across analytics, CAHPS, HOS, and member experience solutions.
- Participate in a learning-oriented culture focused on collaboration, ownership, innovation, and continuous improvement.
- Benefits package and eligibility for a discretionary bonus or commission tied to achieved results.