Provider Quality Consultant
About The Position
The Provider Quality Consultant supports TennCare's Health Starts initiative and serves as the primary liaison between participating provider groups, MCO partners, and TennCare stakeholders. The role leads program implementation, supports workflow design and improvement, manages contract development activities, facilitates governance meetings, and monitors program performance to help achieve successful outcomes. It contributes to integrated healthcare and social care models intended to improve health outcomes for vulnerable populations. The consultant works across provider quality programs and enterprise functions, advising on provider quality performance and improvement initiatives. The role collaborates with multidisciplinary member- and provider-facing teams to execute provider pay-for-quality programs, conducts provider office visits, advises on quality measures, reporting, and data, and recommends actions to improve quality and productivity. It also educates internal and external stakeholders on high-quality care practices and serves as a liaison for quality-support tools. The position requires travel up to 20% of the time.
Requirements
- Bachelor’s degree in a health-related discipline or equivalent work experience.
- At least 3 years of clinical experience or prior experience in public health, healthcare administration, or community health/outreach.
- At least 3 years of experience directly related to HEDIS and/or Quality Improvement, including data analysis and consultation and education for providers and provider staff.
- Demonstrated presentation and team facilitation skills.
- Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint.
- Excellent oral and written communication skills.
- Ability to stay organized and reliable, manage multiple tasks, and demonstrate exceptional work ethic.
- Knowledge of provider quality strategies, programs, and services.
- Ability to travel up to 20% of the time.
Nice To Haves
- Advanced degree in healthcare management, public health, business, or a related field.
- Experience supporting vulnerable populations.
- Familiarity with provider-facing technologies such as EHRs and Clinical Data Exchange platforms.
- For roles supporting the Patient-Centered Medical Home program, NCQA PCMH Content Expert Certification (CCE) is required; the posting says positions requiring this certification will be clearly identified.
Responsibilities
- Serve as the primary liaison between participating provider groups, MCO partners, and TennCare stakeholders.
- Lead program implementation and support workflow design and improvement.
- Manage contract development activities and facilitate governance meetings.
- Monitor program performance to ensure successful outcomes.
- Consult on provider quality performance and improvement initiatives across provider quality and cross-functional enterprise programs.
- Collaborate with multidisciplinary member- and provider-facing teams to execute provider pay-for-quality programs aligned with high-quality care goals.
- Conduct frequent face-to-face or virtual provider office visits and advise on provider performance quality measures, reporting, and data.
- Drive recommendations for action designed to achieve quality and productivity improvement goals.
- Educate internal and external stakeholders on best practices in delivering high-quality care.
- Liaise regarding quality-support tools provided to stakeholders, considering issues beyond purely medical concerns confronting families.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
