Provider Quality & Value Improvement Lead

BlueCross BlueShield of Tennessee; United States; Remote; USD 90,000 - 125,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Provider quality

Presentation skills

MS Office

Communication skills

Organization

Education

Bachelor's Degree in Health-related Discipline

Tools

EHRs

Clinical Data Exchange

Job description

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.