Provider Quality Consultant

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Remote-first organization

Job summary

BlueCross BlueShield of Tennessee, Inc. seeks a Provider Quality Consultant to support TennCare's Health Starts initiative.

You will liaison with provider groups, drive collaboration across providers, MCO partners, and TennCare stakeholders, lead program implementation, and monitor performance to ensure outcomes. You will work with teams to design workflows, manage contracts, and facilitate governance meetings, traveling up to 20% as needed.

Qualifications

• Experience building provider relationships and leading quality improvement initiatives.
• Ability to manage complex programs or projects with multiple stakeholders.
• Familiarity with provider-facing technologies (EHRs, data exchange) is a plus.

Responsibilities

• Interface with provider quality programs and cross-functional teams to drive quality performance.
• Collaborate with multi-disciplinary teams to implement provider pay-for-quality programs.
• Conduct provider visits and advise on performance measures, reporting, and data.

Skills

Provider relationships

Quality improvement

Project management

Stakeholder collaboration

Education

Advanced degree in healthcare management/public health/business

Tools

EHRs

CDX platforms

Job description

Our BlueCare team has an exciting opportunity for a Provider Quality Consultant to support TennCare's innovative Health Starts initiative. In this role, you will serve as the primary liaison between participating provider groups, driving collaboration across providers, MCO partners, and TennCare stakeholders. You will lead program implementation, support workflow design and improvement, manage contract development activities, facilitate governance meetings, and monitor program performance to ensure successful outcomes. This position plays a key role in advancing integrated healthcare and social care models that improve health outcomes for vulnerable populations.

To be successful in this role, you'll bring experience building strong provider relationships, leading quality improvement initiatives, managing complex programs or projects, and collaborating across multiple stakeholders.

Candidates with experience supporting vulnerable populations and familiarity with provider‑facing technologies such as EHRs and Clinical Data Exchange platforms will be especially successful.

An advanced degree in healthcare management, public health, business, or a related field is preferred. Notes: A commitment to leveraging AI‑enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement.

Job Responsibilities

• Interfaces with provider quality programs, as well as with other cross‑functional programs across the Enterprise functioning as consultant on provider quality performance and improvement initiatives.
• Works closely in collaboration with multi‑disciplinary member and provider facing teams to execute provider pay for quality programs which align goals to achieve high quality care.
• Conducts frequent face‑to‑face or virtual provider office visits and functions as subject‑matter consultant on provider performance quality measures, reporting, and data.
• Drives and directs recommendations for action designed to achieve quality and productivity improvement goals.
• Provides education to internal as well as external stakeholders on best practices in delivering high quality care and functions as a liaison regarding quality support tools provided to stakeholders; looking beyond the purely “medical” issues confronting families.
• Exhibit advanced and comprehensive knowledge of value‑based care delivery models, including PCMH, and NCQA Recognition and Accreditation programs, where applicable.
• Demonstrates expertise in core principles, quality and performance measurement, regulatory and compliance requirements, and scalable operational processes necessary to support enterprise‑wide value‑based strategies.
• Must be able to travel up to 20% of the time.

Job Qualifications

• Education Bachelor’s Degree in a Health‑Related Discipline (Nursing, Dietetics, Exercise Science, Counseling, Social work, Healthcare Administration, Public Health, or Health Education), or equivalent work experience required.
• Experience 3 years - Clinical experience or prior experience in public health, healthcare administration, or community health / outreach required.
• 3 years - Experience directly related HEDIS and/or Quality Improvement, with experience in data analysis and providing consultation and education to providers and provider staff required.

Skills\\Certifications

• For roles supporting the Patient‑Centered Medical Home (PCMH) program, NCQA PCMH Content Expert Certification (CCE) is required.
• Positions requiring this certification will be clearly identified in the job posting.
• Demonstrated presentation and team facilitation skills
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Excellent oral and written communication skills
• Be organized, reliable, and able to manage multiple tasks with exceptional work ethic.
• Knowledge of Provider quality strategies, programs, and services N/A

Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity or any other characteristic protected by applicable law.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members. BCBST is a remote‑first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.