Provider Quality Consultant (Tennessee Based)

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

In this role, the Provider Quality Consultant serves as a strategic driver of quality and cost improvement, translating TennCares 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. The Consultant leverages data-driven insights, performance analytics, and cross-functional collaboration to ensure accountability and measurable results aligned with enterprise goals.

This role is ideal for a candidate who demonstrates:

• 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, as well as with other cross-functional programs across the Enterprise functioning as consultant on provider quality performance and improvement initiatives.
• Works closely in collaboration with multi-disciplinary member and provider facing teams to execute provider pay for quality programs which align goals to achieve high quality care.
• Conducts frequent face-to-face or virtual provider office visits and functions as 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 as well as external stakeholders on best practices in delivering high quality care and functions as a liaison regarding quality support tools provided to stakeholders; looking beyond the purely medical issues confronting families.
• Exhibit advanced and comprehensive knowledge of the PCMH Model of Care, as well as NCQAs Recognition Program. This includes demonstrated expertise in the foundational concepts, detailed criteria, and procedural elements integral to the recognition process.
• Must be able to travel up to 20% of the time.

Job Qualifications

Education

• Bachelors 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 - 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.

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
• Be organized, reliable, and able to manage multiple tasks with exceptional work ethic.
• Knowledge of Provider quality strategies, programs, and services

BBEX 11; AEP

Number of Openings Available

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Applying for this job indicates your acknowledgement and understanding of the following statements:

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.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.