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Provider Quality Consultant
BlueCross BlueShield of Tennessee
Tennessee, USA
Full-time
Mid · 3+ years experience
Remote
Discovered 2 weeks ago
Full Job Posting
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 value-based care delivery models, including PCMH, and NCQA Recognition and Accreditation programs, where applicable. Demonstrates expertise in core principles, quality and performance measurement, regulatory and compliance requirements, and scalable operational processes necessary to support enterprise-wide value-based strategies.
- Must be able to travel up to 20% of the time.
- 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 - 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
- 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
- Be organized, reliable, and able to manage multiple tasks with exceptional work ethic.
- Knowledge of Provider quality strategies, programs, and services
- Number of Openings Available
- 1
- Worker Type:
- Employee
- Company:
- VSHP Volunteer State Health Plan, Inc
- 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.
Qualifications
- 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
- 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
- Be organized, reliable, and able to manage multiple tasks with exceptional work ethic.
- Knowledge of Provider quality strategies, programs, and services
- Number of Openings Available
- 1
- Employee
- VSHP Volunteer State Health Plan, Inc
- 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.
- 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.
About BlueCross BlueShield of Tennessee
Health Insurance & Managed Care6600 employeesFounded 1945
Not-for-profit Tennessee health insurer providing employer, individual, Medicare and Medicaid coverage to members.
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