In this role, you will support primarily eastern value-based provider groups, partnering directly with provider organizations to assess performance data, identify opportunities for improvement, and drive better quality, risk adjustment, and population health outcomes. You'll serve as a trusted advisor to providers, leveraging analytics, relationship management, and strategic problem-solving skills to help practices succeed in value-based arrangements while delivering measurable results for members and the organization. This position offers the opportunity to influence provider performance, strengthen partnerships, and support healthcare transformation through data-driven decision-making.
To be successful in this role, in addition to the core job requirements, you'll bring strong analytical capabilities, relationship management skills, customer service expertise, and a proactive approach to problem-solving. The ideal candidate is comfortable interpreting performance data, communicating insights to provider partners, and collaborating with stakeholders to implement strategies that improve outcomes.
Note:
- This role supports primarily eastern value-based provider groups.
- Approximately 25% travel is required, primarily for occasional on-site provider visits.
- Sponsorship is not available for this role.
Job Responsibilities
- Support provider performance strategies across risk adjustment, quality measures, medical loss ratio, incentive programs, and value-based care.
- Analyze provider and population-level data to identify gaps, trends, and opportunities for improvement, and support provider-specific action plans through data segmentation and targeted gap closure strategies.
- Implement targeted strategies to enhance clinical quality outcomes, patient experience, and financial performance.
- Educate and consult providers on quality performance expectations, program requirements, documentation practices, coding accuracy, and evidence-based care opportunities, while resolving complex performance and metric-related issues.
- Align and optimize incentive programs to maximize provider engagement and performance, incorporating quality-based incentives and value-based reimbursement alignment.
- Utilize standardized tools, dashboards, and job aids to support provider engagement and internal team effectiveness, including quality performance reporting and tracking tools.
- Ensure consistent execution of performance initiatives across provider groups, emphasizing quality improvement consistency and best practice adoption.
- Collaborate with internal stakeholders to align strategies supporting quality improvement programs, regulatory requirements, and value-based initiatives.
- Travel as required to support provider performance initiatives (approximately 60% of the time).
Job Qualifications
Education
- Bachelor’s Degree in a Health-Related or Business-Related Discipline or equivalent work experience required.
Experience
- 4 years - Progressive experience in healthcare, quality improvement, or provider performance required.
- Demonstrated experience with risk adjustment, Quality programs (HEDIS, STARS, etc.), value-based care models, and incentive programs or MLR drivers.
Skills & Competencies
- Advanced healthcare data analysis and performance insight development
- Expertise in risk adjustment, HEDIS/STAR quality programs, and value-based care models
- Strong provider consulting and performance improvement capabilities
- Knowledge of healthcare financial drivers including MLR and incentive structures
- Ability to translate analytics into actionable provider strategies
N/A
Number of Openings Available
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
