Medicare Advantage Quality Strategist (STARS & HEDIS)

Highmark; Camp Hill (Cumberland County); On-site; USD 110,000 - 150,000; Full time

Job summary

Highmark Inc. seeks a Medicare Advantage Quality Consultant to optimize government program performance and ROI for PCPs. The role emphasizes hands-on data analysis, strategic planning, and collaboration with interdepartmental teams to transform workflows.

The ideal candidate has extensive Medicare/Medicaid experience, strong data analytics skills, and a background in population health management within ambulatory care settings. 50%–75% travel is required.

Qualifications

• Bachelor's degree in a clinical or healthcare field is required.
• Six years of relevant experience may substitute for a Bachelor's degree.
• Master's degree in a clinical or healthcare field is preferred.

Responsibilities

• Provide hands-on, office-based support to PCPs on Medicare STARS, Medicaid HEDIS and risk revenue.
• Analyze government value-based reports and develop strategic plans to meet targets.
• Identify ROI opportunities across commercial and government programs.
• Present program results to internal and external audiences, including meetings.
• Develop instructional materials for internal and external audiences.
• Assist PCPs with population health tools and analytic interfaces.

Skills

Medicare/Medicaid expertise

Data analysis

Population health

Stakeholder engagement

Project management

Healthcare programs

Communication

Education

Bachelor's Degree in healthcare field

6 years experience in lieu of degree

Master's Degree preferred

Job description

Highmark Inc. seeks a Medicare Advantage Quality Consultant to optimize government program performance and ROI for PCPs. The role emphasizes hands-on data analysis, strategic planning, and collaboration with interdepartmental teams to transform workflows.

The ideal candidate has extensive Medicare/Medicaid experience, strong data analytics skills, and a background in population health management within ambulatory care settings. 50%–75% travel is required.