Medicare Advantage Stars SME
Listed on 2026-09-25
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Doctor/Physician
Healthcare Consultant, Healthcare Management
Description
Who We Are
Healthcare quality is complex. Medisolv helps make it manageable — and actionable.
We partner with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. More than 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs.
With support from Bessemer Venture Partners Forge, we're continuing to grow our platform and expand our impact — investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence.
Reporting to the GM, Performance Intelligence, we are looking for an experienced Medicare Advantage Stars Subject Matter Expert (SME) to join our team.
About the Role
We are seeking a Medicare Advantage (MA) Stars Subject Matter Expert (SME) with deep knowledge of the Medicare Advantage quality, regulatory, measurement, and performance environment. This individual will serve as a subject matter bridge between Medicare Advantage health plans, quality organizations, data/analytics teams, and technology/product development teams.
This is a highly collaborative role for someone who can move comfortably between CMS regulations and technical product requirements, plan quality strategies and data analysis, and business needs and technology development.
The ideal candidate is someone who can read a 100-page CMS technical document in the morning and explain to a software developer that afternoon exactly what needs to be built — someone who understands not only what CMS requires, but how those requirements affect a health plan's operations, data, quality strategy, technology, and Star Rating. The strongest candidates combine three capabilities: deep Medicare Advantage Stars expertise, the analytical ability to turn performance results into actionable insight, and the technology/product fluency to translate regulatory and business requirements into working solutions.
This role is particularly well suited for a Medicare Advantage quality professional who wants to move beyond traditional quality operations and play a central role in building the next generation of Medicare Advantage Stars technology and analytics solutions.
What You'll Do
Medicare Advantage Stars Subject Matter Expertise- Interpret and explain CMS MA and Part D Stars regulations, technical specifications, and guidance — including Advance Notices, Final Rules, Rate Announcements, and Technical Notes
- Assess how changes to Stars measures, methodology, benchmarks, cut points, and weighting affect health plans, and translate those implications into practical terms
- Serve as the internal expert on Medicare Advantage quality measurement and performance improvement
- Define business and functional requirements for MA Stars technology and analytics products, translating regulations and measure specs into data requirements, workflows, and calculations
- Partner with product managers, data scientists, and engineers to ensure technology solutions accurately reflect CMS requirements, reviewing designs and outputs for regulatory accuracy
- Help build tools that identify performance gaps and forecast Star Ratings, and support user acceptance testing to validate Stars-related functionality
- Engage directly with MA health plans to understand their Stars strategies, quality challenges, and data environments
- Analyze plan performance to identify improvement opportunities, gaps, and root causes, and help develop targeted interventions
- Present complex Stars findings clearly to plan…
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