Lead VBC Quality Consultant

Job not on LinkedIn

🔥 53 minutes ago

🐊 Florida, Missouri – Remote

🐊 Florida – Remote 🏰 Missouri – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

👻 Ghost score 10%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Serve as the strategic quality advisor for an assigned portfolio of Value-Based Care organizations • Analyze performance and identify opportunities across Medicare Stars, HEDIS, CAHPS, medication adherence, clinical quality, member experience, and VBC quality goals • Manage approximately 8–10 VBC organizations 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 performance risk • Develop partner-specific quality strategies, action plans, milestones, and accountability mechanisms • Monitor execution, intervene when progress is off track, assess intervention effectiveness, and recommend course corrections • Analyze provider-, measure-, and member-level data to identify performance drivers, care-gap opportunities, emerging risks, and market or provider-group variation • Translate findings into initiatives improving gap closure, medication adherence, preventive care, chronic condition management, and member experience • 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 • 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 and comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Nursing, Public Health, Healthcare Administration, Business Administration, or related field, or equivalent relevant experience • 5+ years 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 utilizing clinical data analytics and outcomes measurement in healthcare • Experience using Excel, Power BI, and PowerPoint • Experience leading external stakeholder meetings and independently managing multiple complex accounts or initiatives preferred • Current or prior RN, LPN/LVN, PA, PharmD, or other relevant clinical licensure preferred; clinical background highly valued but not required

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Comprehensive benefits package, subject to program eligibility