Clinical Consultant

The Enterprise Provider Quality Team at BCBST is seeking a driven and collaborative Clinical Consultant to join a growing enterprise function dedicated to elevating provider performance across all lines of business. You will join a high‑impact team of clinical consultants and data analysts who partner with every line of business to strengthen provider quality scores.

In this role, you will lead end‑to‑end quality improvement projects, transform data into actionable insights, and influence outcomes that help maintain BCBST’s standing as a top performing health plan. Success in this position will rely on your ability to analyze complex quality standards, communicate clearly with diverse stakeholders, and drive meaningful improvement.

Highlights:

• Opportunity to design and implement full life cycle projects that directly impact provider performance and plan quality outcomes
• Extensive collaboration with internal and external partners
• Meaningful exposure across all BCBST lines of business
• Ability to translate data into insights that guide operational and clinical decision making

Our ideal candidates bring:

• Project management experience
• Strong data analysis abilities
• Confidence in public speaking and the ability to present across diverse audiences
• Experience applying quality improvement principles
• Proficiency with HEDIS and CAHPS (strongly preferred)
• 3+ years of quality improvement or CMS Stars experience
• Excitement around (and experience leveraging) approved AI tools (ex: CoPilot) to support efficiencies in this work

Note: An RN license or Bachelor’s in Nursing can be a great match, but we encourage candidates with other relevant health-focused academic backgrounds to apply.

Job Responsibilities

• Assess effectiveness of and create and/or disband/combine clinically focused workgroups as appropriate to support the overall priorities and strategies for HEDIS and health outcomes.
• Manage clinical quality improvement studies, activities and projects; assist and support quality improvement studies, activities and projects.
• Participate in the development and implementation of new clinical projects to support continuous quality improvement; identify potential vulnerabilities and opportunities for improvement.
• Conduct evidence-based literature research to guide and support clinical quality improvement studies and activities; develop supporting presentations and coordinate with workgroups and project teams.
• Effective 10/5/20: This Position requires a 24 month commitment before posting for other internal positions.

Job Qualifications

Education

• Bachelors Degree in Nursing with active RN license in the State of Tennessee or hold a license in the State of their residence if the State is participating in the Nurse Licensure Compact Law; or a Bachelors Degree in healthcare-related field required

Experience

• 3 years - Clinical experience or prior experience in public health or community health / outreach required

Skills\Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Excellent oral and written communication skills

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.