Nicole Cantwell
Consultant - Risk Adjustment
Nicole Cantwell is a strategic healthcare leader and consultant with 15+ years of experience designing, implementing, and leading enterprise programs across HHS and Medicare Advantage Stars, HEDIS, Risk Adjustment, quality improvement, healthcare analytics, and medical record operations. She has extensive payer-side experience translating regulatory, clinical, operational, and data requirements. This translates into actionable strategies that improve quality performance, risk capture, compliance, and financial outcomes.
Recognized for the ability to bridge business, technical, clinical, provider, vendor, and executive teams, translating complex healthcare data and regulatory requirements into practical operational solutions. Experienced in assessing current-state operations, identifying performance gaps, developing targeted interventions, establishing governance and reporting structures, and helping organizations build sustainable internal capabilities.
Deep expertise in HEDIS measurement, Stars strategy, Risk Adjustment operations, RADV readiness, medical record retrieval and abstraction, supplemental data, provider performance, member outreach, vendor oversight, and healthcare data analysis. Skilled in using data to identify opportunities, prioritize populations and measures, monitor interventions, and communicate performance to stakeholders at all organizational levels.
Nicole previously held multiple risk adjustment positions at Blue Cross Blue Shield of Kansas City.
