DIRECTOR OF PROVIDER SERVICES - 64330

Executive Service

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

This position requires a background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview:

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system payment reform. The Provider Services Division (PS) is an integral team within the TennCare Chief Medical Office (CMO) responsible for supporting the provider enrollment process, supporting the TennCare provider experience, and overseeing strong provider networks for TennCare members. Operationally, the PS division is comprised of approximately 25 team members. Provider Registration supports compliance with federal and state provider screening and enrollment requirements. Network Adequacy initiatives ensure development of and compliance with network adequacy standards required of TennCare managed care contractors (MCCs).

Provider Experience efforts focus on implementing and evaluating strategic plans to support medical, dental, pharmacy, behavioral health, and home and community-based providers and their experiences with TennCare. Lastly, data analytics drive improved insights and data connections for the agency and with other authorized data users focused on measuring key performance indicators. The Provider Services Director is a senior leader of the CMO and leads the overall coordination of provider initiatives across the agency through daily leadership and management for each team within Provider Services. The Provider Services Director also works closely with MCCs and providers to establish strong relationships to advance their partnership in service to TennCare members. This position works closely with external and internal stakeholders to oversee and lead the key PS functions of enrollment, education, and network monitoring activities.

Key Responsibilities:

• Provide daily leadership and accountability for each Provider Services unit to design, execute and oversee TennCare's provider services strategy.

Responsibilities for each team include:

• Develop, implement, and coordinate a comprehensive provider engagement strategy across the TennCare CMO that supports proactive communication and outreach to TennCare providers
• Provide management and oversight of Provider Registration, Credentialing and Network monitoring activities within the Provider Services Division
• Oversee MCC network adequacy management contract requirements, review data validation surveys, and identify new measures to track and measure patient access
• Develop and maintain positive, long-term relationships with physicians, healthcare providers and healthcare systems to support and improve relationships with TennCare and its MCCs
• Coordinate with key TennCare teams and MCCs to ensure efficient and high-quality transfer of necessary provider information and education materials
• Identify new best practices and opportunities for continued advancement and evolution of a intentional and engaging provider experience with TennCare Provide exceptional customer service and collaborate effectively with internal and external stakeholders to problem-solve provider issues and develop systemic solutions
• Lead cross-functional initiatives with TennCare and its MCCs to resolve high-priority individual medical care issues for providers and/or members to ensure appropriate care is delivered
• Guide data analyses to identify opportunities and develop systemic solutions addressing operational challenges that can improve efficiency of provider processes and provider experience
• Oversee MCCs and other contracted organizations to monitor and assure the contracted vendors meet contractual requirements and deliver services efficiently and effectively
• Design strategic initiatives, lead project management, and develop reporting mechanisms to track successes, and opportunities for improvement across PS units
• Support PS team's timely responses to provider information requests submitted to TennCare through emails, call centers, legislators, or other communication channels Support key Medical Office initiatives focused on improving the TennCare Provider experience and strengthening staff connections to provider engagement
• Partner closely with TennCare CMO Divisions and senior leadership to lead key CMO projects that focus on building high-quality networks and support provider engagement. Key examples include TennCare Patient Centered Medical Homes, TN Health Links, BESMART, Provider Data Analytics
• Assist with professional development of Provider Services and other Medical Office teams toward a better understanding of how provider interactions may be improved Engage with local providers across the state and represent TennCare nationally in forums focused on improving provider relationships and network adequacy
• Conduct in-person provider site-visits and meet provider leadership across the state to foster strong relationships directly with practicing providers and facilities
• Foster professional working relationships with key professional organizations (TNAAP, TMA, THA, TPA, etc.) to provide education on common provider issues and questions
• Identify and research national best practices to leverage across the TennCare program
• Attend and present at national, state-wide or regional provider association conferences and other public forums to provide education on TennCare programs and available provider support

Minimum Qualifications:

• Bachelor's degree from an accredited college or university in related field (master's degree in health care related field highly preferred
• MBA, MPH, MPP, or MHA) AND 5+ years in health care management or operations.
• Experience interpreting policy or procedural provisions for a related health insurance or provider organization is preferred.
• Experience in analyzing data and using data to drive performance and expectations.

OR

• an equivalent combination of education and work experience may be considered.

Desirable qualifications:

• Prior experience leading and managing teams and direct reports
• Strong, clear, and concise oral and written communication skills
• Strong interpersonal communication and customer services skills including extensive experience in public speaking and developing engaging presentations
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines
• Master's degree in health care administration, public health, business administration, communications, or related field
• Experience in project management and data analysis
• Strong proficiency in Microsoft Office Software (Excel, Access, Word, and PowerPoint)
• Strong experience in a heavily audited environment or in direct health care operations

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.