Clinical Consultant

BlueCross BlueShield of Tennessee • Chattanooga, TN

1d • Remote

About The Position

The Enterprise Provider Quality Team at BCBST is seeking a driven and collaborative Clinical Consultant to join a growing enterprise function dedicated to elevating provider performance across all lines of business. You will join a high‑impact team of clinical consultants and data analysts who partner with every line of business to strengthen provider quality scores. In this role, you will lead end‑to-end quality improvement projects, transform data into actionable insights, and influence outcomes that help maintain BCBST’s standing as a top performing health plan. Success in this position will rely on your ability to analyze complex quality standards, communicate clearly with diverse stakeholders, and drive meaningful improvement. Highlights: Opportunity to design and implement full life cycle projects that directly impact provider performance and plan quality outcomes Extensive collaboration with internal and external partners Meaningful exposure across all BCBST lines of business Ability to translate data into insights that guide operational and clinical decision making Our ideal candidates bring: Project management experience Strong data analysis abilities Confidence in public speaking and the ability to present across diverse audiences Experience applying quality improvement principles Proficiency with HEDIS and CAHPS (strongly preferred) 3+ years of quality improvement or CMS Stars experience Excitement around (and experience leveraging) approved AI tools (ex: CoPilot) to support efficiencies in this work Note: An RN license or Bachelor’s in Nursing can be a great match, but we encourage candidates with other relevant health-focused academic backgrounds to apply.

Requirements

• Bachelors Degree in Nursing with active RN license in the State of Tennessee or hold a license in the State of their residence if the State is participating in the Nurse Licensure Compact Law; or a Bachelors Degree in healthcare-related field required
• 3 years - Clinical experience or prior experience in public health or community health / outreach required
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Excellent oral and written communication skills

Nice To Haves

• Project management experience
• Strong data analysis abilities
• Confidence in public speaking and the ability to present across diverse audiences
• Experience applying quality improvement principles
• Proficiency with HEDIS and CAHPS (strongly preferred)
• 3+ years of quality improvement or CMS Stars experience
• Excitement around (and experience leveraging) approved AI tools (ex: CoPilot) to support efficiencies in this work

Responsibilities

• Assess effectiveness of and create and/or disband/combine clinically focused workgroups as appropriate to support the overall priorities and strategies for HEDIS and health outcomes.
• Manage clinical quality improvement studies, activities and projects; assist and support quality improvement studies, activities and projects.
• Participate in the development and implementation of new clinical projects to support continuous quality improvement; identify potential vulnerabilities and opportunities for improvement.
• Conduct evidence-based literature research to guide and support clinical quality improvement studies and activities; develop supporting presentations and coordinate with workgroups and project teams.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level