Payer STARS/Quality Clinical Consultant, Senior Manager

Join PwC's Health Services consulting practice as a Payer STARS/Quality Clinical Consultant, Senior Manager, based in Newburgh Heights, Cuyahoga County. In this full-time role, you'll advise leading health plans and payer organizations on clinical quality improvements and performance optimization strategies.

About the Role

You'll lead strategic consulting engagements with major payer and health services clients, helping them enhance clinical quality outcomes and STARS metrics. This position combines strategic advisory work with hands-on leadership, requiring you to spend significant time at client sites (up to 80% travel). You'll work directly with senior executives and operational teams to identify improvement opportunities, design implementation strategies, and drive measurable results across quality programs and member outcomes.

What You'll Do

• Lead consulting engagements from strategy through implementation for health plan quality and performance initiatives
• Develop clinical quality improvement strategies grounded in STARS metrics, regulatory requirements, and industry benchmarks
• Analyze operational and clinical data to surface improvement opportunities and quantify business impact
• Build and maintain strong client relationships at all levels, serving as the primary strategic advisor for complex, long-term initiatives
• Mentor and supervise junior consultants; oversee quality and completeness of client recommendations
• Stay informed on emerging trends in health plan quality programs, value-based care models, and healthcare policy

What We're Looking For

• 7+ years of experience in health plan operations, clinical quality programs, managed care, or healthcare consulting
• Advanced clinical background or healthcare operations expertise; graduate degree in healthcare administration, business, nursing, or related field preferred
• In-depth knowledge of STARS metrics, quality improvement frameworks, and Medicare Advantage or commercial payer operations
• Strong consulting, analytical, and communication abilities; experience influencing senior executives with data-driven insights
• Proven track record managing multiple client engagements and leading cross-functional teams
• Ability and willingness to travel up to 80% for client work

About PwC

PwC is a global professional services firm committed to solving complex business challenges across health services, financial services, technology, and other sectors. Our Health Services consulting practice partners with leading health plans, providers, and payers to drive operational improvement and sustainable growth.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.