• Leitung eigener Kundenprojekte von der Anforderungsaufnahme bis zur Umsetzung • Implementierung unserer Lösungen in Microsoft 365/SharePoint • Aktive Mitarbeit bei der Weiterentwicklung unserer Projekt- und Unternehmensplattform

• Provide comprehensive support to a federal organization to drive transformational change • Collaborate directly with senior level clients in a fast-paced environment to shape and execute strategy • Engage stakeholders, manage internal operations, communications, and program execution

We are seeking a dedicated, experienced, and forward‑thinking Clinical Consultant to join the team at BlueCross BlueShield of Tennessee In this role, the Clinical Consultant serves as a strategic driver of clinical quality improvement, translating enterprise priorities into actionable initiatives that improve quality of care for our members, HEDIS, and overall quality performance. Day to day, this role partners with clinical, operational, and external stakeholders to assess performance, identify opportunities, design and implement interventions, and sustain measurable improvement over time. The Consultant applies sound clinical judgment, leverages multidisciplinary resources, and ensures consistent follow‑up and accountability to achieve optimal outcomes while supporting enterprise goals. This role is ideal for someone who offers the following capabilities and strengths: - Experience leading quality initiatives from planning through execution - Ability to manage multiple priorities with strong attention to detail - Comfortable presenting to varied audiences and influencing without authority - Clinical background with Quality and/or HEDIS experience preferred - Strong analytical, technical, and digital skills - Creative and adaptable; eager to responsibly leverage enterprise‑approved AI and technology to improve care and efficiency Note: - Although we are based in Chattanooga, TN, this is a fully remote role. - Sponsorship is not available for this position. 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 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. 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.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant (RN) – Fully Remote Remote | Full-Time | RN License Required We’re seeking a motivated, detail-oriented Utilization Management Nurse Consultant (UMNC) to join our collaborative, fast-paced team. In this fully remote role, you’ll use your clinical expertise to ensure members receive the right care, at the right time, in the right setting—while supporting quality outcomes and appropriate benefit utilization. What You’ll Do - Review clinical records to determine medical necessity using established criteria and guidelines - Coordinate and communicate with providers, facilities, and internal partners to support safe, effective care - Facilitate efficient discharge planning and care transitions - Apply clinical judgment to coverage determinations across the continuum of care - Identify opportunities to improve quality, efficiency, and member outcomes - Meet standard productivity and quality expectations in a dynamic environment Schedule & Work Environment - Monday–Friday 8-hour shift between 8:00am–6:00pm (local time zone) - Open to PST and MST candidates to support extended coverage - Saturday rotation required - Up to 10% travel for audits - Fully remote, sedentary role requiring extended computer and phone use Required Qualifications - Active, unrestricted RN license in the state where you reside - 2+ years recent acute care hospital experience (within the past 10 years) - Strong computer skills, including Microsoft Word, Excel, and PowerPoint - Excellent written and verbal communication skills - Highly organized, detail-oriented, and comfortable multitasking Preferred Qualifications - Utilization Review or Managed Care experience - Strong telephonic communication skills Education - Associate Degree in Nursing required - BSN preferred Ready to bring your clinical expertise beyond the bedside—without sacrificing flexibility? Apply today and make an impact from home. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $32.01 - $68.55 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 05/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.