Provider Quality Consultant

BlueCross BlueShield of Tennessee; United States; À distance; USD 90 000 - 125 000; Plein temps

Résumé du poste

VSHP Volunteer State Health Plan, Inc is seeking a Provider Quality Consultant to lead quality improvement initiatives and serve as the liaison among provider groups, MCO partners, and TennCare stakeholders. The role emphasizes collaboration, education, and data-driven decision making to advance value-based care.

The ideal candidate will have 3+ years in clinical or healthcare administration, experience with HEDIS/Quality Improvement, and familiarity with EHRs and data exchange platforms.

Qualifications

• Bachelor's degree in a health-related discipline or equivalent.
• 3+ years of clinical experience or healthcare administration.
• 3 years HEDIS/Quality Improvement with data analysis experience.
• Experience building provider relationships and working with stakeholders.
• Advanced degree in healthcare management, public health, business, or related field preferred.

Responsabilités

• Interfaces with provider quality programs and cross-functional teams to drive quality performance improvements.
• Collaborate with multi-disciplinary teams to execute provider pay-for-quality programs.
• Conduct provider visits and serve as a subject-matter expert on performance measures and data.
• Lead recommendations to achieve quality and productivity improvements.
• Educate internal and external stakeholders on best practices for high-quality care.
• Demonstrate knowledge of value-based care models (PCMH, NCQA) and regulatory requirements.
• Travel up to 20% of the time.

Connaissances

Provider quality

Presentation skills

MS Office

Communication skills

Organization

Formation

Bachelor's Degree in Health-related Discipline

Outils

EHRs

Clinical Data Exchange

Description du poste

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), orequivalent 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

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Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.