Provider Quality Consultant

Our BlueCare team has an exciting opportunity for a Provider Quality Consultant to support TennCare's innovative Health Starts initiative. In this role, you will serve as the primary liaison between participating provider groups, driving collaboration across providers, MCO partners, and TennCare stakeholders.

About the role

You will lead program implementation, support workflow design and improvement, manage contract development activities, facilitate governance meetings, and monitor program performance to ensure successful outcomes. This position plays a key role in advancing integrated healthcare and social care models that improve health outcomes for vulnerable populations.

A commitment to leveraging AI-enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement is expected.

Responsibilities

• Interface 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.
• Work 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.
• Conduct frequent face-to-face or virtual provider office visits and function as subject-matter consultant on provider performance quality measures, reporting, and data.
• Drive and direct recommendations for action designed to achieve quality and productivity improvement goals.
• Provide education to internal as well as external stakeholders on best practices in delivering high-quality care and function as a liaison regarding quality support tools provided to stakeholders; looking beyond the purely “medical” issues confronting families.
• Exhibit advanced and comprehensive knowledge of value-based care delivery models, including PCMH, and NCQA Recognition and Accreditation programs, where applicable.
• Demonstrate expertise in core principles, quality and performance measurement, regulatory and compliance requirements, and scalable operational processes necessary to support enterprise-wide value-based strategies.
• Travel up to 20% of the time.

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

Skills

• For roles supporting the Patient-Centered Medical Home (PCMH) program, NCQA PCMH Content Expert Certification (CCE) is required. Positions requiring this certification will be clearly identified in the job posting.
• Demonstrated presentation and team facilitation skills.
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• Excellent oral and written communication skills.
• Organized, reliable, and able to manage multiple tasks with exceptional work ethic.
• Knowledge of provider quality strategies, programs, and services.

One opening available. Employee position with Volunteer State Health Plan, Inc.