Consultant, Medicare Stars & Regulatory Performance Improvement

Press Ganey is the leading experience measurement, data analytics, and insights provider for complex industries—a status earned over decades of deep partnership with clients to help them understand and meet the needs of their key stakeholders. Our roots are in U.S. healthcare, and today we serve clients globally across industries to improve the Human Experiences at the heart of their business. We combine technology, data, and expertise to enable clients to pinpoint opportunities, accelerate improvement, and build lifetime loyalty among customers and employees.

About the role

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 critical quality measures.

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.

Requirements

• 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 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 serving millions of Medicare beneficiaries.

Pay

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 relevant skills, training, experience, education, and market factors. 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.

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, please contact acommodations@pressganey.com.