Provider Quality Consultant

BlueCross BlueShield of Tennessee

Provider Quality Consultant at BlueCross BlueShield of Tennessee focusing on quality and cost improvement initiatives. Collaborating with healthcare partners to enhance care delivery and performance outcomes.

Posted 6/4/2026full-timeRemote • Tennessee • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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 NCQA’s Recognition Program. This includes demonstrated expertise in the foundational concepts, detailed criteria, and procedural elements integral to the recognition process.

Requirements

What you’ll need

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.

Benefits

Comp & perks

NCQA PCMH Content Expert Certification required.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisHEDISquality improvementprovider performance quality measuresPCMH Model of CareNCQA Recognition Program

Soft Skills

presentation skillsteam facilitationoral communicationwritten communicationorganizational skillsreliabilitytask managementwork ethic

Certifications

NCQA PCMH Content Expert Certification