Provider Quality Consultant

Overview

Join the BlueCare team and contribute to TennCare's innovative Health Starts initiative as a Provider Quality Consultant. This role requires acting as the primary interface between provider groups and multiple stakeholders, including MCO partners and TennCare, to foster collaboration and drive program success.

Key Responsibilities

• Lead the implementation of healthcare quality programs, coordinating with cross-functional teams to support pay-for-quality initiatives aimed at enhancing care standards.
• Conduct in-person and virtual visits with providers, serving as a subject matter expert on performance measures, quality data, and reporting.
• Provide actionable recommendations to improve healthcare quality and operational productivity.
• Offer guidance and education to both internal and external stakeholders on best practices for delivering high-quality care that addresses broader family health issues.
• Demonstrate expertise in value-based care models including PCMH and NCQA accreditation programs, and ensure compliance with related regulatory and quality measurement standards.
• Travel up to 20% to support provider engagement and program goals.

Qualifications

• Bachelor’s degree in health-related fields such as Nursing, Dietetics, Exercise Science, Counseling, Social Work, Healthcare Administration, Public Health, or equivalent experience.
• Minimum of three years' clinical or public health experience, including healthcare administration or community outreach.
• At least three years of direct experience with HEDIS and quality improvement initiatives, including skills in data analysis and provider consultation.
• For PCMH support roles, NCQA PCMH Content Expert Certification (CCE) is mandatory.
• Strong presentation and team facilitation capabilities.
• Proficiency in Microsoft Office suite (Outlook, Word, Excel, PowerPoint).
• Excellent verbal and written communication skills.
• Highly organized, dependable, and capable of managing multiple priorities effectively.
• Thorough knowledge of provider quality strategies, programs, and related services.

Additional Information

• The role embraces the use of AI-enabled tools to increase efficiency and support continuous process improvements.
• The hiring entity is VSHP Volunteer State Health Plan, Inc affiliated with BlueCross BlueShield of Tennessee.
• BlueCross BlueShield of Tennessee is committed to equal employment opportunity and prohibits discrimination based on protected categories as per applicable laws.
• Applicants and recruiting firms should note the company does not accept unsolicited recruitment assistance without formal agreements.
• One vacancy is available for this position.