Lead VBC Quality Consultant: Medicare Stars & HEDIS Remote

Centene Corporation; Florida; Hybride; USD 110 000 - 170 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements: remote,hyb

Résumé du poste

Centene Corporation seeks a Lead VBC Quality Consultant to act as the strategic quality advisor for a portfolio of Value-Based Care organizations in the U.S. The role analyzes performance, develops improvement strategies, and partners with provider networks to enhance Medicare Stars, HEDIS and CAHPS outcomes.

The role requires extensive experience in Medicare quality and data analytics, with strong collaboration across internal teams and external partners.

Qualifications

• Bachelor's degree in Nursing, Public Health, Healthcare Administration, Business Administration, or related field required.
• 5+ years of experience in Medicare quality improvement, Medicare Stars, population health, or closely related work.
• Strong knowledge of CMS Medicare Stars and NCQA HEDIS specifications and performance improvement methods.
• Experience interpreting and utilizing clinical data analytics to drive change using Excel, Power BI and PowerPoint.
• Experience leading external stakeholder meetings and independently managing multiple complex accounts or initiatives.
• RN license or other relevant clinical licensure preferred

Responsabilités

• Manage a portfolio of approximately 8–10 VBC organizations and serve as the primary national quality contact for assigned accounts.
• Establish annual, quarterly, and monthly quality priorities based on contract goals and performance trends.
• Develop partner-specific quality strategies, action plans, milestones, and accountability mechanisms; monitor execution.
• Track performance against Medicare Stars, HEDIS, CAHPS, medication adherence, clinical quality, member experience and VBC goals.
• Analyze provider-, measure-, and member-level data to identify performance drivers and risks.
• Translate complex findings into focused initiatives to improve gap closure and patient outcomes.
• Assess intervention effectiveness and share best practices across the VBC portfolio.
• Support performance forecasting and executive reporting.
• Partner with Market Quality, Network, Provider Engagement, Analytics, Pharmacy, Risk Adjustment, Clinical Operations and Data/EMR teams.
• Lead cross-functional workgroups addressing barriers, data issues and workflow needs.
• Provide provider insights to inform national strategy and resource allocation.
• Performs other duties as assigned and complies with policies.

Connaissances

Value-Based Care experience

Medicare quality experience

Power BI

Excel

PowerPoint

Formation

Bachelor's degree in Nursing, Public Health, Healthcare Administration, Business Administration, or related field

Master's degree preferred

RN license or related clinical licensure preferred

Outils

Power BI

Excel

PowerPoint

Description du poste

Centene Corporation seeks a Lead VBC Quality Consultant to act as the strategic quality advisor for a portfolio of Value-Based Care organizations in the U.S. The role analyzes performance, develops improvement strategies, and partners with provider networks to enhance Medicare Stars, HEDIS and CAHPS outcomes.

The role requires extensive experience in Medicare quality and data analytics, with strong collaboration across internal teams and external partners.