Payer STARS/Quality Clinical Consultant, Senior Manager

Specialty/Competency: Operations
Industry/Sector: Health Services
Time Type: Full time
Travel Requirements: Up to 80%

At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance. As an operations consulting generalist at PwC, you will possess a broad understanding of various aspects of operations consulting. You will provide comprehensive guidance and support to clients in optimising operational efficiency and effectiveness. Working in this area, you will analyse client needs, develop operational solutions, and offer recommendations tailored to specific business requirements.

Growing as a strategic advisor, you leverage your influence, expertise, and network to deliver quality results. You motivate and coach others, coming together to solve complex problems. As you increase in autonomy, you apply sound judgment, recognising when to take action and when to escalate. You are expected to solve through complexity, ask thoughtful questions, and clearly communicate how things fit together. Your ability to develop and sustain high performing, diverse, and inclusive teams, and your commitment to excellence, contributes to the success of our Firm.

Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:

• Craft and convey clear, impactful and engaging messages that tell a holistic story.
• Apply systems thinking to identify underlying problems and/or opportunities.
• Validate outcomes with clients, share alternative perspectives, and act on client feedback.
• Direct the team through complexity, demonstrating composure through ambiguous, challenging and uncertain situations.
• Deepen and evolve your expertise with a focus on staying relevant.
• Initiate open and honest coaching conversations at all levels.
• Make difficult decisions and take action to resolve issues hindering team effectiveness.
• Model and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firm's code of conduct, and independence requirements.

The Opportunity

As part of the Operations Consulting team, you will lead cross-functional teams in achieving performance in Medicare Stars and related quality initiatives through advanced clinical data strategies. As a Senior Manager, you will build trust with multi-level teams and stakeholders, motivating and coaching others to solve complex problems. This position provides an exciting opportunity to influence quality improvement initiatives and drive impactful change in healthcare data management.

Responsibilities

- Lead cross-functional teams to achieve exceptional performance in quality initiatives

- Motivate and coach team members to address complex challenges

- Build trust with stakeholders at multiple levels

- Influence quality improvement initiatives in healthcare data management

- Develop advanced clinical data strategies for impactful change

- Confirm alignment with Medicare Stars and related programs

- Drive collaboration across teams to enhance performance

- Analyze clinical data sources to inform decision-making

What You Must Have

- Bachelor's Degree

- At least 8 years of experience

What Sets You Apart

- Master's Degree in Health Administration preferred

- Demonstrating in-depth clinical data management experience

- Leading multidisciplinary teams in clinical data operations

- Managing large-scale quality improvement initiatives

- Communicating technical insights to non-technical audiences

- Developing frameworks for improving data reliability

- Understanding regulatory compliance in Medicaid and Medicare

- Utilizing AI/ML tools for clinical data accuracy

Learn more about how we work:

PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy:

As PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law. 

For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.

Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines:

The salary range for this position is: $124,000 - $280,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: