Lead VBC Quality Consultant

Centene Corporation•Remote-MO, MO

About The Position

The Lead VBC Quality Consultant serves as the strategic quality advisor for an assigned portfolio of Value-Based Care organizations, managing approximately 8–10 organizations and acting as the primary national quality contact for assigned accounts. The role analyzes performance, identifies opportunities, develops quality improvement strategies, and partners with provider organizations to improve Medicare Stars, HEDIS, CAHPS, and other quality outcomes. It is the primary quality liaison between internal teams and external provider partners and is accountable for coordinating execution, monitoring results, and escalating barriers. The consultant establishes quality priorities based on contract goals, performance trends, population needs, and performance risks. They develop partner-specific strategies and action plans, monitor milestones and accountability, analyze provider-, measure-, and member-level data, and translate findings into initiatives to improve care-gap closure, medication adherence, preventive care, chronic condition management, and member experience. The role also supports performance forecasting, executive reporting, assessment of interventions, course corrections, and sharing scalable practices across the VBC portfolio. The consultant works with Market Quality, Network, Provider Engagement, Analytics, Pharmacy, Risk Adjustment, Clinical Operations, Data/EMR teams, and leadership to align strategy and execution; leads or contributes to cross-functional workgroups; and shares provider insights and recurring barriers to inform national strategy, resource allocation, and process improvement. Other duties may be assigned, and the employee must comply with all policies and standards. A bachelor’s degree in Nursing, Public Health, Healthcare Administration, Business Administration, or a related field, or equivalent relevant experience, is required. A master’s degree is preferred. The position requires at least five years of experience in Medicare quality improvement, Medicare Stars, HEDIS, population health, or closely related work, as well as demonstrated ability to analyze healthcare performance data and turn findings into actionable strategies. Strong knowledge of CMS Medicare Stars, NCQA HEDIS specifications, and performance improvement methods is required. Experience using clinical data analytics and outcomes measurement to drive change with tools such as Excel, Power BI, and PowerPoint is also required. Experience leading external stakeholder meetings and independently managing multiple complex accounts or initiatives is preferred. Value-Based Care experience and Medicare Quality experience are highly preferred. Current or prior relevant clinical licensure is valued but not required. Centene describes its work as supporting access to care and healthier lives. It offers a comprehensive benefits package and a flexible approach to work, with remote, hybrid, field, or office work schedules. Actual pay may vary based on skills, experience, education, and other job-related factors, including full-time or part-time status; total compensation may include incentives, and benefits may be subject to eligibility.

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 closely related work.
Demonstrated experience analyzing healthcare performance data and converting findings into actionable strategies.
Strong knowledge of CMS Medicare Stars and NCQA HEDIS specifications and performance improvement methods.
Experience interpreting and using clinical data analytics and healthcare outcomes measurement to drive change, including use of Excel, Power BI, and PowerPoint.

Nice To Haves

Master’s degree.
Experience leading external stakeholder meetings and independently managing multiple complex accounts or initiatives.
Value-Based Care experience and Medicare Quality experience are highly preferred.
Current or prior RN, LPN/LVN, PA, PharmD, or other relevant clinical licensure; clinical background is highly valued but not required.

Responsibilities

Manage a portfolio of approximately 8–10 Value-Based Care organizations and serve as the primary national quality contact for assigned accounts.
Establish annual, quarterly, and monthly quality priorities based on contract goals, performance trends, population needs, and identified performance risks.
Develop partner-specific quality strategies, action plans, milestones, and accountability mechanisms; monitor execution and intervene when progress is off track.
Track performance against Medicare Stars, HEDIS, CAHPS, medication adherence, clinical quality, member experience, and applicable VBC quality goals.
Analyze provider-, measure-, and member-level data to identify performance drivers, care-gap opportunities, emerging risks, and variation across markets or provider groups.
Translate complex findings into focused initiatives to improve gap closure, medication adherence, preventive care, chronic condition management, and member experience.
Assess intervention effectiveness, recommend course corrections, and share scalable best practices across the VBC portfolio.
Support performance forecasting, executive reporting, and prioritization of high-impact measures and populations.
Partner with Market Quality, Network, Provider Engagement, Analytics, Pharmacy, Risk Adjustment, Clinical Operations, Data/EMR teams, and leadership to align strategy and execution.
Lead or contribute to cross-functional workgroups addressing performance barriers, data issues, provider workflow needs, and enterprise quality priorities.
Bring provider insights and recurring barriers to internal teams to inform national strategy, resource allocation, and process improvement.
Perform other duties as assigned.
Comply with all policies and standards.