Partnering for Clinical Excellence and Quality Outcomes
Driving Performance Across Clinical, Quality, and Stars Programs​
At Rebellis Group, we bring deep expertise in clinical operations, quality improvement, and CMS Stars strategy to help health plans achieve measurable results. Our multidisciplinary teams work collaboratively to design, implement, and optimize programs that improve member outcomes, ensure compliance, and elevate plan performance.
Clinical Operations Support
Our Clinical Team delivers strategic and operational guidance to strengthen care management (CM), utilization management (UM), and clinical compliance.
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We help health plans:
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Design and optimize Medical Management workflows
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Conduct prior authorization list assessments to streamline approvals and reduce administrative burden
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Implement evidence-based CM models
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Improve coordination across providers and vendors
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Ensure regulatory alignment with CMS and NCQA standards
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Provide interim clinical leadership and staffing
Quality Improvement & Accreditation
Our Quality Team partners with health plans to build and refine quality programs that drive measurable performance and meet accreditation standards.
Our services include:
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Quality strategy development and execution
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HEDIS and CAHPS performance improvement
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NCQA accreditation readiness and support
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Audit preparation and mock reviews
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Vendor oversight and performance management
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Customized Training Programs for clinical and quality teams, including documentation best practices, regulatory updates, and performance improvement techniques
We offer both live and virtual training formats tailored to your team’s needs, ensuring your staff is equipped with the knowledge and tools to succeed in a rapidly evolving healthcare landscape.
Stars Program Strategy
Our Stars Team helps Medicare Advantage plans improve their CMS Star Ratings through targeted interventions and data-driven strategies.
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We support plans with:
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Stars gap analysis and roadmap development
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Member and provider engagement strategies
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Review of Plan data analytics and predictive modeling
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Interdisciplinary collaboration across departments
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Performance monitoring and reporting
Special Needs Plans & Model of Care Support
Rebellis Group provides specialized consulting for Special Needs Plans (SNPs), helping health plans meet CMS requirements and deliver high-quality, coordinated care to vulnerable populations.
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Our SNP services include:
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Development and refinement of the Model of Care (MOC)
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Execution support for MOC implementation across departments
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CMS MOC submission and compliance readiness
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Staff training on SNP-specific protocols and care coordination
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Performance monitoring and reporting aligned with SNP goals
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We ensure your SNP programs are not only compliant but also effective in improving outcomes for dual-eligible, institutional, and chronic condition populations.
Why Choose Rebellis Group?
Experienced Consultants
Experienced Consultants with deep payer and provider knowledge
Tailored Solutions
Tailored Solutions for Medicare Advantage, Medicaid, ACA, Commercial, and US Family Health Plans
Proven Results
Proven Results in improving quality scores, reducing inappropriate denials, and enhancing member satisfaction
Flexible Engagement Models
Flexible Engagement Models including project-based consulting and interim leadership