Provider Quality Consultant (Tennessee Based)

We are seeking a dedicated, experienced, and forward-thinking professional to join BlueCross BlueShield of Tennessee.

In this role, you will serve as a strategic driver of quality and cost improvement, translating TennCare's priorities into actionable initiatives that enhance quality performance, HEDIS outcomes, and overall care delivery for our members. This position partners closely with provider groups, clinical teams, operational leaders, and external stakeholders to assess performance, identify opportunities, and design and implement sustainable improvement strategies.

Ideal Candidate Profile

• 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.

Additional Information

• This is a fully remote position, although the team is based in Chattanooga, TN. Candidates must reside in the state of TN.
• Must be able to travel up to 20% of the time.
• Sponsorship is not available for this role.
• NCQA PCMH Content Expert Certification required.

Job Responsibilities

• Interfaces with provider quality programs and cross-functional teams as a consultant on performance and improvement initiatives.
• Collaborates with multi-disciplinary teams to execute provider pay-for-quality programs.
• Conducts frequent face-to-face or virtual provider office visits, serving as a subject-matter expert on quality measures, reporting, and data.
• Drives recommendations for action to achieve quality and productivity improvement goals.
• Provides education to internal and external stakeholders on best practices for high-quality care.
• Exhibits advanced knowledge of the PCMH Model of Care and NCQA's Recognition Program.

Job Qualifications

Education

• 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.

Experience

• 3 years of clinical experience or prior experience in public health, healthcare administration, or community health/outreach.
• 3 years of experience directly related to HEDIS and/or Quality Improvement, with experience in data analysis and providing consultation to providers.

Skills & Certifications

• 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.
• Strong organizational skills and work ethic.
• Knowledge of provider quality strategies, programs, and services.

Company Commitment

BCBST will recruit, hire, train, and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.