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Quality Performance Consultant

Employment type: 
Full time
Remote Position: 
Required degree level: 


Initiates and leads performance measurement-related projects for BCBSA Commercial Markets, specifically related to Network Solutions clinical quality. Supports the assessment of the impact of industry provider measurement initiatives and population health on Network Solutions or other Commercial Markets initiatives. Actively participates as part of an integrated project team and engages in project planning, primary and secondary research and analysis, and findings and recommendations.

Responsible for the day-to-day communication with BCBS Plans and cross-divisional team members in clinical quality measurement projects. Impacts all Licensees and BCBSA organization. Regular interactions with Plan-based workgroups and Plan c-suite staff in multiple disciplines. Promote Plan interests by providing advocacy for Blue strategies, priorities and policies at national industry and policy committees. Deliverable could include BCBSA responses to industry standard and guidelines related to tiered or narrow network or products.


Responsibilities include but are not limited to:

  • Supports provider measurement projects for developing and implementing the Network Solutions or other Commercial Markets initiatives. Collaborate with key internal and external stakeholders to identify implications to BCBS Plans' Commercial Markets business operations. Lead business needs; strategy, policy, and operational recommendations to satisfy business and operationalize the requirements.
  • Lead appropriate Plan workgroups and forums for Network Solutions and Commercial Markets initiatives, synthesizing recommendations from a variety of stakeholders including clinical and data experts in order to make recommendations, working across Association departments.
  • Monitor industry trends (cost, quality, population health), and support system-wide responses to public comment periods. Apply knowledge and make recommendations on Plan and Commercial Markets initiatives.
  • As assigned, provide support to provider measurement to ensure implementation by BCBSA and Plans is successful and completed within the BCBSA budgets. Develop recommendations to meet evolving BCBSA and Plan needs on Network Solutions and other commercial market initiatives.
  • Develop and maintain key contacts and effective working relationships with internal and external stakeholders including measurement organizations and third-party vendors as necessary to enhance knowledge of issues and to ensure the most effective collection and dissemination of information.


Required Basic Qualifications:

  • A bachelor's degree in a business discipline or equivalent experience (such as provider cost or quality performance)
  • A minimum of 3 years' healthcare experience or provider/health Plan measurement experience or healthcare equivalent
  • Knowledge of hospital and physician performance measurement is essential
  • Working knowledge of Microsoft Office Suite

Preferred Basic Qualifications:

  • Understanding of the commercial health insurance marketplace is desirable
  • Measurement program development is desirable
  • Academy for Healthcare Management or other industry-related certification is preferred

Equal Opportunity Employer

Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics

Make an impact on healthcare in America. A career with Blue Cross Blue Shield Association allows you to be part of the foundation that supports the 35 Blue Cross and Blue Shield companies nationwide, while protecting and strengthening the Blue Cross Blue Shield brand. Our work is helping provide greater access to cost-effective healthcare, improve the health of America and build stronger communities. With a commitment to diversity, equity and inclusion, we celebrate different cultures, languages, backgrounds and experiences while striving to advance health equity, and we want you to join Team BCBSA.

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