Consultant, Medicare Stars & Regulatory Performance Improvement

Company Description

Press Ganey is the leading experience measurement, data analytics, and insights provider for complex industries—a status we earned over decades of deep partnership with clients to help them understand and meet the needs of their key stakeholders. Our earliest roots are in U.S. healthcare –perhaps the most complex of all industries. Today we serve clients around the globe in every industry to help them improve the Human Experiences at the heart of their business. We serve our clients through an unparalleled offering that combines technology, data, and expertise to enable them to pinpoint and prioritize opportunities, accelerate improvement efforts and build lifetime loyalty among their customers and employees.

Like all great companies, our success is a function of our people and our culture. Our employees have world-class talent, a collaborative work ethic, and a passion for the work that have earned us trusted advisor status among the world’s most recognized brands. As a member of the team, you will help us create value for our clients, you will make us better through your contribution to the work and your voice in the process. Ours is a path of learning and continuous improvement; team efforts chart the course for corporate success.

Our Mission:

We empower organizations to deliver the best experiences. With industry expertise and technology, we turn data into insights that drive innovation and action. 

Our Values:

To put Human Experience at the heart of organizations so every person can be seen and understood. 

• Energize the customer relationship: Our clients are our partners. We make their goals our own, working side by side to turn challenges into solutions. 

• Success starts with me: Personal ownership fuels collective success. We each play our part and empower our teammates to do the same. 

• Commit to learning: Every win is a springboard. Every hurdle is a lesson. We use each experience as an opportunity to grow. 

• Dare to innovate: We challenge the status quo with creativity and innovation as our true north. 

• Better together: We check our egos at the door. We work together, so we win together. 

Press Ganey is committed to providing reasonable accommodations to qualified individuals with disabilities or disabled veterans in the hiring process. If you need assistance or an accommodation to apply for a position online or for your interviews or assessments, please contact us at [email protected] Please provide your contact information and the details of your request so we can best assist you.

Location: Remote (U.S.-Based)
Travel: Up to 50%

Shape the Future of Medicare Advantage Performance

Health plans today face unprecedented challenges, including evolving CMS regulations, increasing pressure to improve quality outcomes, rising member expectations, and tighter financial margins.

At Press Ganey, we help health plans navigate these complexities and achieve measurable results. Through industry-leading expertise in quality, member experience, analytics, and regulatory performance, we partner with organizations to improve Star Ratings, optimize member outcomes, enhance operational effectiveness, and drive sustainable growth.

We are seeking a Consultant to join our Stars Consulting Center of Excellence. This role is ideal for a Medicare Advantage professional who combines strong analytical capabilities with deep knowledge of Stars performance and regulatory quality programs. You will work directly with health plan leaders to identify opportunities, solve complex challenges, and deliver strategies that improve performance across the most critical quality measures.

What You'll Do

As a Senior Consultant, you will serve as a trusted advisor to health plans, helping clients improve quality performance and achieve strategic objectives.

Key Responsibilities

• Lead consulting engagements focused on Medicare Stars and regulatory performance improvement.
• Analyze and interpret data across HEDIS, CAHPS, HOS, Part D, operational measures, and Special Needs Plans (SNPs).
• Conduct performance assessments, measure trending, gap analyses, cut-point modeling, and root cause analyses.
• Develop executive-level recommendations and actionable improvement strategies based on data insights.
• Partner with health plan and medical group stakeholders to identify opportunities for quality, experience, and operational improvement.
• Design and facilitate workshops, training sessions, and process improvement initiatives.
• Manage project plans, timelines, deliverables, budgets, and engagement outcomes.
• Build strong client relationships and serve as a primary point of contact throughout engagements.
• Monitor CMS guidance, regulatory requirements, and technical specification updates, translating changes into meaningful client recommendations.
• Collaborate with cross-functional teams to integrate Stars consulting strategies with analytics, CAHPS, HOS, and member experience solutions.

Areas of Consulting Impact

Stars Center of Excellence

Provide end-to-end consulting support across HEDIS, CAHPS, HOS, Part D, and SNPs, helping health plans improve performance, close quality gaps, enhance member outcomes, and maximize Star Ratings.

Regulatory Readiness

Guide clients through evolving CMS and state requirements by conducting readiness assessments, simulations, and strategic planning initiatives aligned to quality, compliance, and Stars performance goals.

Performance Stabilization & Transformation

Support organizations during critical business transitions, including M&A integrations, organizational restructuring, and SNP launches, through governance design, stakeholder alignment, quality program optimization, and sustainable performance improvement strategies.

Qualifications

Required

• 2+ years of experience in health plan quality, Medicare Stars, healthcare consulting, experience management, or performance improvement.
• Hands-on experience supporting Dual/SNP and MA Star Ratings performance.
• Knowledge of one or more quality domains, including HEDIS, CAHPS, HOS, Part D, medication adherence, or quality operations.
• Strong analytical and problem-solving skills with experience using Excel, Access, SQL, SAS, or similar tools.
• Demonstrated success driving measurable quality or performance improvement initiatives.
• Exceptional written, verbal, and presentation skills.
• Ability to influence stakeholders and communicate effectively with executive audiences.
• Advanced proficiency in Microsoft Office Suite, particularly Excel and PowerPoint.
• Strong project management and organizational skills.
• Bachelor's degree required.

Why Press Ganey?

This is an opportunity to join a high-impact consulting team that helps some of the nation's leading health plans improve quality, elevate member experience, and achieve stronger business results. You'll work on meaningful challenges, collaborate with industry experts, and directly influence the performance of programs that serve millions of Medicare beneficiaries.

If you're passionate about Medicare Advantage quality and want to help shape the future of Stars performance, we'd like to hear from you.

Don’t meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Press Ganey we are dedicated to building a diverse, inclusive and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

Additional Information for US based jobs:

Press Ganey Associates LLC is an Equal Employment Opportunity/Affirmative Action employer and well committed to a diverse workforce. We do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, and basis of disability or any other federal, state, or local protected class. 

Pay Transparency Non-Discrimination Notice – Press Ganey will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 

The expected base salary for this position ranges from $90,000 to $125,000.  It is not typical for offers to be made at or near the top of the range. Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, licensure or certifications obtained. Market and organizational factors are also considered. In addition to base salary and a competitive benefits package, successful candidates are eligible to receive a discretionary bonus or commission tied to achieved results. 

All your information will be kept confidential according to EEO guidelines.

Our privacy policy can be found here: https://www.pressganey.com/legal-privacy/