Volunteer State Health Plan, Inc

Healthcare

ProviderQualityConsultant(TennesseeBased)

$75–110k ~AI est. USA, TN, Chattanooga, Remote FULL TIME Remote Friendly
Market Sentiment
HIGH DEMAND

Neural analysis suggests this role is
optimal for Mid+ candidates.

The Brief

“Provider Quality Consultant (Tennessee Based) at Volunteer State Health Plan, Inc. Skills: Provider quality, Quality improvement, HEDIS, Data analysis. Serve as strategic driver of quality and cost. Translate priorities into actionable initiatives”

What You'll Achieve.

Enhance quality performance; Enhance HEDIS outcomes; Enhance overall care delivery; Achieve quality improvement goals; Achieve productivity improvement goals; Improve quality; Improve efficiency

Industry & Context.

Healthcare
Problems you'll solve

Analytical capabilities; Translate data into actionable insights

Eligibility Requirements

Reside in the state of TN, Travel up to 20%

What They're Looking For.

Must Have

Bachelor's Degree or equivalent work experience, 3 years clinical experience or public health/healthcare administration/community health/outreach, 3 years HEDIS/Quality Improvement experience, Experience in data analysis, Experience providing consultation and education to providers and provider staff, NCQA PCMH Content Expert Certification required

Nice to Have

Clinical background not required

What You'll Do.

Serve as strategic driver of quality and cost

Translate priorities into actionable initiatives

Enhance quality performance

Enhance HEDIS outcomes

Enhance overall care delivery

Partner with provider groups

Partner with clinical teams

Partner with operational leaders

Partner with external stakeholders

Identify opportunities

Design improvement strategies

Implement sustainable improvement strategies

Leverage data-driven insights

Leverage performance analytics

Ensure accountability

Ensure measurable results

Interface with provider quality programs

Interface with cross-functional programs

Consult on provider quality performance

Consult on provider quality improvement

Collaborate with multi-disciplinary teams

Execute provider pay for quality programs

Align goals to achieve high quality care

Conduct provider office visits

Serve as subject-matter consultant on provider performance quality

Serve as subject-matter consultant on reporting

Serve as subject-matter consultant on data

Drive recommendations for action

Direct recommendations for action

Achieve quality improvement goals

Achieve productivity improvement goals

Provide education on best practices

Function as liaison regarding quality support tools

Exhibit knowledge of PCMH Model of Care

Exhibit knowledge of NCQA Recognition Program

Leverage enterprise-approved AI

Leverage technology to improve quality

Leverage technology to improve efficiency

How You'll Work.

Team & Collaboration

Provider groups; Clinical teams; Operational leaders; External stakeholders; Multi-disciplinary teams; Provider facing teams; Member facing teams; Internal stakeholders; External stakeholders

Communication Scope

Presenting to diverse audiences; Influencing provider partners; Influencing stakeholders; Oral communication; Written communication

Full Job Description

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 TennCare’s 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

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