Provider Quality Consultant

🔥 11 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• 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.

🎯 Requirements

• 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. • 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. • For roles supporting the Patient-Centered Medical Home (PCMH) program, NCQA PCMH Content Expert Certification (CCE) is required. • 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

🏖️ Benefits

• Paid time off • Remote work options • Professional development opportunities