Provider Quality Consultant (Tennessee Based)

BlueCross BlueShield of Tennessee•Nashville, TN

1d•Remote

About The Position

BlueCross BlueShield of Tennessee is seeking a Provider Quality Consultant to drive quality and cost improvement initiatives. This role translates TennCare's priorities into actionable strategies to enhance quality performance, HEDIS outcomes, and member care delivery. The Consultant will collaborate with provider groups, clinical teams, operational leaders, and external stakeholders to assess performance, identify opportunities, and implement sustainable improvement strategies. Utilizing data-driven insights and performance analytics, the position ensures accountability and measurable results aligned with enterprise goals. The ideal candidate will have proven experience in leading quality improvement initiatives, strong organizational skills, confidence in presenting to diverse audiences, experience with provider networks and quality metrics, and strong analytical and digital capabilities. This is a fully remote position requiring Tennessee residency and up to 20% travel.

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.
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
Candidates must reside in the state of TN.
Must be able to travel up to 20% of the time.

Nice To Haves

Proven experience leading quality or performance improvement initiatives from strategy through execution
Strong organizational skills with the ability to manage multiple priorities and maintain attention to detail
Confidence presenting to diverse audiences and influencing provider partners and stakeholders without direct authority
Experience working with provider networks, quality metrics, and/or HEDIS (clinical background not required)
Strong analytical, technical, and digital capabilities, with the ability to translate data into actionable insights
A proactive, innovative mindset with a willingness to leverage enterprise-approved AI and technology to improve quality and efficiency

Responsibilities

Interfaces with provider quality programs and other cross-functional programs across the Enterprise as a consultant on provider quality performance and improvement initiatives.
Collaborates closely with multi-disciplinary member and provider facing teams to execute provider pay for quality programs that align goals to achieve high quality care.
Conducts frequent face-to-face or virtual provider office visits and serves as a 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 and external stakeholders on best practices in delivering high quality care and serves as a liaison regarding quality support tools provided to stakeholders, looking beyond purely medical issues.
Exhibits advanced and comprehensive knowledge of the PCMH Model of Care and NCQA’s Recognition Program, including foundational concepts, detailed criteria, and procedural elements integral to the recognition process.
Must be able to travel up to 20% of the time.