Consultant, Medicare Stars & Regulatory Performance Improvement
About The Position
Press Ganey is seeking a Consultant to join their Stars Consulting Center of Excellence. This role is for a Medicare Advantage professional with strong analytical capabilities and deep knowledge of Stars performance and regulatory quality programs. The consultant will work directly with health plan leaders to identify opportunities, solve complex challenges, and deliver strategies that improve performance across critical quality measures. The role involves leading consulting engagements, analyzing data (HEDIS, CAHPS, HOS, Part D, operational measures, SNPs), conducting performance assessments, developing recommendations, partnering with stakeholders, facilitating workshops, managing projects, building client relationships, and staying updated on CMS guidance. The consulting impact areas include the Stars Center of Excellence, Regulatory Readiness, and Performance Stabilization & Transformation.
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 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 skills with experience using Excel, Access, SQL, SAS, or similar tools.
- Demonstrated success driving measurable quality or performance improvement initiatives.
- Exceptional written, verbal, and presentation skills.
- Ability to influence stakeholders and communicate effectively with executive audiences.
- Advanced proficiency in Microsoft Office Suite, particularly Excel and PowerPoint.
- Strong project management and organizational skills.
- Bachelor's degree required.
Responsibilities
- Lead consulting engagements focused on Medicare Stars and regulatory performance improvement.
- Analyze and interpret data across HEDIS, CAHPS, HOS, Part D, operational measures, and Special Needs Plans (SNPs).
- Conduct performance assessments, measure trending, gap analyses, cut-point modeling, and root cause analyses.
- Develop executive-level recommendations and actionable improvement strategies based on data insights.
- Partner with health plan and medical group stakeholders to identify opportunities for quality, experience, and operational improvement.
- Design and facilitate workshops, training sessions, and process improvement initiatives.
- Manage project plans, timelines, deliverables, budgets, and engagement outcomes.
- Build strong client relationships and serve as a primary point of contact throughout engagements.
- Monitor CMS guidance, regulatory requirements, and technical specification updates, translating changes into meaningful client recommendations.
- Collaborate with cross-functional teams to integrate Stars consulting strategies with analytics, CAHPS, HOS, and member experience solutions.
Benefits
- Competitive benefits package
- Discretionary bonus or commission tied to achieved results
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What This Job Offers
Job Type
Full-time
Career Level
Senior
