Provider Quality Consultant

Location: Remote, USA; Chattanooga, Tennessee. Travel of up to 20% required, including frequent face-to-face or virtual provider office visits.

Company

hirify.global provides health insurance and healthcare programs, including BlueCare and TennCare initiatives.

What you will do

• Serve as the primary liaison among participating provider groups, MCO partners, TennCare stakeholders, and internal teams.
• Implement provider quality and pay-for-quality programs aligned with high-quality care goals.
• Design and improve workflows, support contract development, facilitate governance meetings, and manage complex program activities.
• Conduct provider visits and advise on quality measures, performance reporting, data, and improvement actions.
• Educate internal and external stakeholders on high-quality care practices and quality support tools.
• Support value-based care strategies, including PCMH and NCQA recognition and accreditation programs, while considering medical and social needs.

Requirements

• Bachelor’s degree in a health-related discipline, including nursing, dietetics, exercise science, counseling, social work, healthcare administration, public health, or health education, or equivalent work experience.
• At least 3 years of clinical experience or experience in public health, healthcare administration, community health, or outreach.
• At least 3 years of directly related HEDIS and/or quality improvement experience, including data analysis and consultation and education for providers and provider staff.
• Demonstrated presentation and team facilitation skills.
• Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint.
• Excellent oral and written communication skills; strong organization, reliability, multitasking ability, and work ethic.
• Knowledge of provider quality strategies, programs, and services.
• For roles supporting the PCMH program, NCQA PCMH Content Expert Certification (CCE) is required when the position is identified as requiring it.

Nice to have

• Experience supporting vulnerable populations.
• Familiarity with provider-facing technologies such as EHRs and Clinical Data Exchange platforms.
• Advanced degree in healthcare management, public health, business, or a related field.

Culture & Benefits

• Full-time employee position supporting an enterprise-wide healthcare quality initiative.
• Commitment to using AI-enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement.
• Collaboration across multidisciplinary member-facing, provider-facing, enterprise, MCO, and TennCare teams.
• Equal employment opportunity across protected characteristics.