Senior Consultant, Member Experience

Health plans and healthcare providers are navigating an increasingly complex landscape marked by evolving quality frameworks, shifting regulatory standards, and rising expectations from the populations they serve. As a Senior Consultant in Member Experience, you will serve as a trusted advisor bringing health plans and healthcare providers together.

In this role, you will be at the forefront of a major industry shift: bridging the traditional divide between payers and providers to improve the end-to-end patient and member journey. Working directly with health plan leaders, medical groups, and clinical operations teams, you will combine deep operational healthcare knowledge with proven continuous improvement methodologies to build strong cross-entity partnerships, elevate quality metrics, and drive measurable performance across Star Ratings and CAHPS. If you are passionate about being a change agent whose work directly impacts the care and lives of millions of people nationwide, this role is for you.

• Payer-Provider Bridge Builder: Understands the operational realities of both health plans and medical provider groups; builds genuine collaboration and trust across executive leaders, physician groups, and clinical staff.
• Continuous Improvement Driver: Skilled in applying structured problem-solving and quality improvement frameworks (e.g., Plan-Do-Study-Act / PDSA cycles) to uncover root causes and build sustainable operational workflows.
• Coach & Facilitator: Comfortably engages and trains diverse audiences—from executive roundtables and town halls to clinic managers and frontline teams—through interactive virtual sessions and hands-on onsite workshops.
• Data-to-Action Interpreter: Adept at reading and interpreting complex performance metrics (CAHPS, HEDIS, HOS, Star Ratings) and translating them into clear, practical roadmaps without getting lost in technical reporting.
• Adaptable & Client-Centric: Thrives in a dynamic consulting environment, easily shifting between strategic advisory, remote delivery, and onsite client facilitation across diverse regions.

• Expand Scope of Influence: Broaden your reach beyond a single health system or payer to guide dozens of medical groups and major regional/national health plans across the country.
• Lead Cutting-Edge Transformation: Be an active driver in one of healthcare’s most critical evolutions—uniting health plans and provider networks into collaborative care partners.
• Hone Executive Advisory & Facilitation: Deepen your expertise in leading high-stakes client engagements, executive coaching, office hours, and collaborative exchange programs.
• Deepen Quality & Regulatory Expertise: Strengthen your mastery of modern healthcare quality programs, value-based care models, Medicare Advantage Star Ratings, Medicaid, and Commercial lines of business.

• Bridge Health Plans & Provider Networks: Collaborate with health plan liaison teams and medical practices to align on shared quality goals, improve communications, and strengthen provider-payer relationships.
• Drive Direct Performance Improvement: Partner with provider practices and clinical groups to lead operational improvement initiatives, utilizing methodologies such as Plan-Do-Study-Act (PDSA) to enhance patient and member interactions.
• Facilitate Training & Coaching: Deliver impactful virtual and onsite workshops, town halls, office hours, and coaching sessions through collaborative initiatives (such as our HX Exchange program).
• Interpret Performance & Survey Metrics: Analyze and interpret CAHPS, HEDIS, HOS, and Star Ratings data alongside operational metrics to identify performance gaps and track measurable progress.
• Manage End-to-End Client Engagements: Lead client project scopes, stakeholder alignment, and delivery timelines, ensuring initiatives translate into sustainable, measurable outcomes.

• Experience: 5+ years of relevant experience in healthcare operations, performance improvement, provider relations, or health plan operations.
• Provider Operations Background: Strong background working directly within healthcare provider settings (e.g., as a Practice Manager, Practice Director, Clinic Operations Lead, or Provider Relations Specialist) with direct insight into clinic workflows and clinical staff engagement.
• Dual Payer/Provider Experience (Strong Plus): Exposure to both health plan/payer operations (e.g., Medicare Advantage, Commercial, or Medicaid) and provider environments is highly preferred.
• Quality & Survey Frameworks: Practical familiarity with healthcare quality metrics and survey frameworks, including CAHPS, HCAHPS, HEDIS, HOS, Patient Experience (PX), and Value-Based Care programs.
• Core Tool Proficiency: Strong proficiency in Microsoft Office (PowerPoint, Excel, Word), with the demonstrated ability to review, interpret, and present data-driven insights effectively.
• Education: Bachelor’s degree required; Master’s degree preferred.
• Travel Flexibility: Ability and willingness to travel nationwide based on client needs (ttravel is client-dependent and can range from remote periods up to 75% travel during onsite engagements.).

• High-Impact Work: Our team directly influences the care experience and health outcomes of millions of members nationwide.  This is accomplished by the team's passion to work collaboratively with both payers and providers to enhance the patient/member experience.
• Collaborative & Advisory-Led: We work hand-in-hand with our clients and internal cross-functional experts, building true partnerships to support change management that is meaningful for both payers and providers.
• Commitment to Growth: Continuous learning is embedded in how we work; team members are given immediate autonomy, executive visibility, and opportunities to stretch their skills across diverse client challenges.
• Data-Driven & Purpose-Focused: We combine rigorous analytical methodology with a deep human-centered purpose to navigate the evolving healthcare ecosystem.
• Nationwide Scale & Purpose: Our team shapes the member and patient experience across the country, from regional health plans to large national health systems, touching millions of lives.