Medicare Advantage Quality Consultant - CPA Market
Core
Subject matter expert providing strategic, hands-on support to primary care providers (PCPs) enrolled in government value-based reimbursement programs to drive performance, cost control, and ROI.
Role type
Senior clinical quality consultant (Medicare/Medicaid)
Builds
Strategic improvement plans and workflow transformations for PCPs
Domain
Healthcare administration, government value-based reimbursement, population health
Deliverable
dashboards & analysis
Required skills
Medicare STARS, Medicaid HEDIS, risk revenue analysis, data interpretation, strategic planning, primary care operations, population health management, continuous improvement methodologies
Preferred skills
Lean, Six Sigma, TQI, TQC, health plan provider network performance management
Technologies
Predictive analytic tools, population health management tools
Responsibilities
Conduct chart reviews and mass claims adjustments; analyze government value-based reimbursement reports; develop strategic plans to meet program targets; present program results to internal and external audiences; provide training on user interfaces and analytic tools; manage individual PCP caseloads and projects.
Seniority
Senior, hands-on IC
