Provider Quality Consultant

🕒 July 30

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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👻 Ghost score 65%

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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

• Serve as the primary liaison between participating provider groups, MCO partners, and TennCare stakeholders • Lead program implementation • Support workflow design and improvement • Manage contract development activities • Facilitate governance meetings • Monitor program performance to ensure successful outcomes • Interface with provider quality programs and cross-functional enterprise programs as a consultant on provider quality performance and improvement initiatives • Collaborate with multidisciplinary member- and provider-facing teams to execute provider pay-for-quality programs • Conduct frequent face-to-face or virtual provider office visits • Advise on provider performance quality measures, reporting, and data • Drive recommendations for quality and productivity improvement • Educate internal and external stakeholders on best practices for delivering high-quality care • Serve as liaison regarding quality support tools provided to stakeholders • Advance integrated healthcare and social care models for vulnerable populations • Apply knowledge of value-based care delivery models, PCMH, NCQA recognition and accreditation programs, quality and performance measurement, regulatory and compliance requirements, and scalable operational processes

🎯 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 of clinical experience or prior experience in public health, healthcare administration, or community health/outreach required • 3 years of experience directly related to HEDIS and/or Quality Improvement, with experience in data analysis and providing consultation and education to providers and provider staff required • NCQA PCMH Content Expert Certification (CCE) required for roles supporting the Patient-Centered Medical Home (PCMH) program when the position is identified as requiring it • Demonstrated presentation and team facilitation skills • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) • Excellent oral and written communication skills • Organized, reliable, and able to manage multiple tasks with exceptional work ethic • Knowledge of provider quality strategies, programs, and services

🏖️ Benefits

• Must be able to travel up to 20% of the time • Employee worker type

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