Provider Clinical Quality Specialist

Blue Cross & Blue Shield of Mississippi; Flowood (MS); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

401(k) plan

Paid time off

On-site gym and café

Job summary

Blue Cross & Blue Shield of Mississippi is seeking a Provider Clinical Quality Specialist to enhance quality programs related to Women’s Health and Maternal Care. This role involves analyzing clinical guidelines and collaborating with network providers to achieve best practices.

Candidates should hold a Bachelor’s degree in nursing and possess significant clinical experience. The position offers competitive compensation and ample benefits, including a supportive work environment focused on employee wellness.

Qualifications

• Bachelor’s degree in nursing and an unrestricted R.N. licensure in Mississippi.
• Three years’ clinical experience as a nurse or nurse practitioner.
• Ability to work a flexible schedule and undertake limited or frequent travel.

Responsibilities

• Research, analyze, and document clinical best-practice guidelines.
• Present actionable data to network providers.
• Maintain knowledge of provider quality initiatives and reimbursement models.

Skills

Clinical best-practice guidelines

Professional presentation skills

Data interpretation

Microsoft Office proficiency

Education

Bachelor's degree in nursing

Tools

Microsoft Access

Microsoft Visio

Job description

Blue Cross & Blue Shield of Mississippi is committed to building a healthier Mississippi. We are seeking a Provider Clinical Quality Specialist to develop, implement, and maintain quality programs related to Women’s Health and Maternal Care. The role partners with network providers, hospitals, and internal stakeholders to evaluate and enhance a best‑practice, value‑based program, ensuring consistent alignment with clinical outcomes.

Primary Responsibilities

• Research, analyze, and document clinical best‑practice guidelines and related quality measures aligned with evidence‑based standards and value‑based reimbursement models.
• Document technical specifications for quality measures used for internal reporting and external transparency with network providers.
• Present actionable data to network providers, sharing current quality performance scores against expectations and identifying improvement opportunities.
• Maintain knowledge of provider quality initiatives and value‑based reimbursement models such as MACRA, BPCI, and PQRS.
• Build effective relationships internally and externally, advocating for best‑practice quality models.

Position Requirements

• Bachelor’s degree in nursing and an unrestricted R.N. licensure in Mississippi, or an advanced practice degree.
• Three years’ clinical experience as a nurse or nurse practitioner.
• Experience implementing activities to monitor and improve health‑related outcomes.
• Professional presentation skills, able to explain technical information to non‑technical audiences.
• Intermediate proficiency with Microsoft Office (Word, Excel).
• Ability to work a flexible schedule and undertake limited or frequent travel.

Preferred Qualifications

• Master’s degree in nursing or healthcare administration.
• In‑depth knowledge of Women’s Health and obstetrics best practices.
• Proficiency with Microsoft Access and Visio.
• Knowledge of CPT, HCPCS, ICD‑10, UB, and NDC coding.
• Data interpretation and statistical analysis skills for healthcare trends.
• Background in developing provider/hospital quality management programs.
• Understanding of BPCI and PQRS value‑based programs.
• Familiarity with accreditation programs such as JCAHO and NCQA.

Benefits and Working Environment

The role offers a competitive compensation package that includes medical benefits, a 401(k) plan, ample paid time off, and a schedule supporting work/life balance. On‑site amenities such as a gym, café, and walking track enhance employee wellness. Monthly team events foster community and collaboration.

Equal Opportunity Statement

Blue Cross & Blue Shield of Mississippi is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.