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Position Purpose:
The Lead VBC Quality Consultant serves as the strategic quality advisor for an assigned portfolio of Value-Based Care organizations. 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. The consultant serves as the primary quality liaison between internal teams and external provider partners and is accountable for coordinating execution, monitoring results, and escalating barriers.
Key Details: Value-Based Care experience and Medicare Quality experience highly preferred.
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, performance trends, population needs, and identified performance risk.
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 that 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 that address performance barriers, data issues, provider workflow needs, and enterprise quality priorities.
Bring provider insights and recurring barriers back to internal teams to inform national strategy, resource allocation, and process improvement.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience:
Bachelor's Degree Nursing, Public Health, Healthcare Administration, Business Administration, or related field, or equivalent relevant experience. required
Master's Degree preferred
: 5+ years experience in Medicare quality improvement, Medicare Stars, HEDIS, population health, or closely related work. required Demonstrated experience analyzing healthcare performance data and converting findings into actionable strategies. required Strong knowledge of CMS Medicare Stars and NCQA HEDIS specifications and performance improvement methods. required
Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change utilizing programs like Excel, Power BI and, PowerPoint. required
Experience leading external stakeholder meetings and independently managing multiple complex accounts or initiatives. preferred
Licenses/Certifications:
RN - Registered Nurse - State Licensure and/or Compact State Licensure Current or prior RN, LPN/LVN, PA, PharmD, or other relevant clinical licensure; clinical background is highly valued but not required. preferred
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
