VBC / Quality Strategist

Location: Shelton, CT (Hybrid - 3 days in a month)
Employment Type: Full-Time
Experience: 8 Years

Job Summary

We are seeking an experienced Value-Based Care (VBC) / Quality Strategist to support healthcare provider organizations in improving quality performance, care gap closure, risk adjustment, and value-based reimbursement outcomes.

The ideal candidate will have strong expertise in healthcare quality programs, including HEDIS, CMS STARS, MIPS, ACO/MSSP, PCMH, and HCC risk adjustment. This individual will work closely with provider organizations, clinical leadership, and population health teams to develop and implement strategies that improve quality scores, optimize clinical workflows, and maximize performance under value-based care arrangements.

This is a client-facing consulting role requiring strong analytical, advisory, communication, and stakeholder management skills.

Key Responsibilities

Value-Based Care Strategy & Quality Improvement

• Provide strategic consulting and advisory support to healthcare provider organizations on value-based care and quality improvement initiatives.

• Evaluate client performance across HEDIS, STARS, MIPS, APMs, ACO/MSSP, and payer-specific quality programs.

• Develop actionable improvement plans to enhance quality scores, close care gaps, and improve reimbursement outcomes.

• Guide healthcare organizations on HCC coding accuracy, risk adjustment, chronic condition documentation, and Annual Wellness Visit programs.

• Support PCMH recognition, ACO participation, and value-based payer contract performance.

• Integrate quality improvement strategies into clinical workflows, EHR documentation, and population health processes.

Quality Analytics & Performance Reporting

• Develop and deliver quality performance dashboards, reports, and analytical insights for clinical and executive leadership.

• Conduct HEDIS and STARS gap analyses and identify opportunities for quality improvement.

• Monitor performance against quality benchmarks, regulatory requirements, and value-based contract targets.

• Present performance trends, improvement opportunities, and strategic recommendations to stakeholders.

Client & Stakeholder Engagement

• Lead client advisory sessions, quarterly business reviews, and quality strategy meetings.

• Collaborate with CMOs, Quality Directors, Population Health teams, and healthcare executives.

• Communicate CMS quality program updates, HEDIS measure changes, and payer-specific regulatory developments.

• Build strong client relationships and serve as a trusted advisor for value-based care and quality initiatives.

Cross-Functional Collaboration

• Collaborate with healthcare technology, EHR, Revenue Cycle Management (RCM), and Account Management teams.

• Support EHR optimization for quality measure documentation, care gap alerts, and population health workflows.

• Align HCC risk adjustment initiatives with clinical documentation and revenue cycle operations.

• Develop quality improvement resources, implementation guides, and care gap closure strategies.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Clinical Sciences, Health Informatics, or a related field, or equivalent professional experience.

• 5–8 years of experience in healthcare quality improvement, Value-Based Care, Population Health Management, or Managed Care Operations.

• Minimum 3 years of experience in a client-facing consulting, advisory, or strategic role supporting healthcare provider organizations.

• Strong working knowledge of:

  • HEDIS Quality Measures

  • CMS STARS Ratings and Methodology

  • MIPS (Merit-Based Incentive Payment System)

  • ACO / MSSP Programs

  • APM (Alternative Payment Models)

  • HCC Coding and Risk Adjustment

  • PCMH Recognition

  • Value-Based Care Contracting

• Experience with quality performance analytics, population health platforms, and EHR-based quality reporting.

• Understanding of clinical quality improvement methodologies such as PDSA and Lean.

• Strong analytical, presentation, communication, and stakeholder management skills.

• Ability to manage multiple client engagements and travel as required.

Preferred Qualifications

• CPHQ (Certified Professional in Healthcare Quality)

• RHIA or equivalent healthcare quality / health informatics certification.

• Experience working with healthcare providers, ACOs, payer organizations, and population health teams.

• Experience developing quality improvement roadmaps and performance dashboards.

Key Skills

Value-Based Care (VBC), Healthcare Quality Improvement, HEDIS, CMS STARS, MIPS, ACO, MSSP, APM, HCC Coding, Risk Adjustment, PCMH, Population Health Management, Care Gap Closure, Quality Analytics, Clinical Documentation, EHR, PDSA, Lean, Healthcare Consulting, Client Relationship Management.