THL PROGRAM DIRECTOR - 76727

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.

Background Check:

This position requires a criminal 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 Quality Improvement Division is an integral team within the Medical Office that is responsible for monitoring, reporting, and leading innovative strategies focused on improving clinical quality and health outcomes. Operationally, the Quality Improvement Division works closely with several TennCare divisions to lead the development and execution of a comprehensive quality strategy. Additionally, the Quality Improvement team plays a strategic role in TennCare initiatives focused on improving clinical care and outcomes for TennCare members, including primary care transformation and population health. Externally, the Quality Improvement Division works closely with TennCare's contracted organizations and other state agencies to provide oversight of quality performance and data reporting for TennCare members.

The Tennessee Health Link (THL) Program Director is responsible for the strategic and operational leadership of TennCare's THL program, a key component of the agency's behavioral health and value-based care strategy. This role oversees program implementation, innovation, and performance monitoring, and serves as the primary liaison to internal and external stakeholders including providers, managed care organizations (MCOs), consultants, and advocacy groups. The position also leads the redesign of the THL program in partnership with external advisors, oversees the distribution strategy for the Transitions of Care shared savings initiative, supports the relaunch of the Care Coordination Tool, and develops TennCare's annual CMS directed payment application to secure federal funding for behavioral health transformation.

Key Responsibilities:

• THL Program Operations
• Maintain full ownership over THL program and day-to-day operations, providing management over strategic initiatives
• Utilize project management skills to ensure timelines for high-priority analytics or strategic initiatives are complete, accurate, and timely
• Serve as primary point of contact with MCO leadership in addressing updates, questions, and concerns regarding THL Program
• Develop and coordinate official communication to THL providers as needed including newsletter content, webinars, and memos
• Develop and present content for stakeholder meetings and calls Maintain, optimize, and provide quality assurance support for program documents (i.e., provider reports, report templates, Detailed Business Requirements, Provider Operating Manual, etc.) Develop and maintain strong partnerships with stakeholders including providers, vendors, managed care staff, and external groups
• Provide guidance and timelines for both providers and MCOs for the onboarding of new organizations THL Program Updates
• Scope, map, and prioritize all initiatives and program enhancements to ensure alignment with program goals
• Partner with senior leaders in the agency and externally to optimize program outcomes and efficiencies
• Communicate and make recommendations on strategic enhancements for the program with executive leadership
• Design, run and interpret data analysis to determine strategic next steps for programmatic enhancements Strategic Responsibilities
• Lead the strategic redesign of the THL program in partnership with McKinsey & Company, including development of a tiered reimbursement structure, evaluation of eligibility criteria, and identification of new efficiency and quality metrics
• Serve as subject matter expert for the relaunch of the Care Coordination Tool (CCT), ensuring alignment with provider workflows and TennCare's value-based care goals
• Develop TennCare's annual CMS Directed Payment Application for the THL program, including data analysis and narrative justification to secure federal match funding
• Support implementation of redesign recommendations and ensure alignment with TennCare's behavioral health transformation strategy
• Coordinate with internal and external stakeholders to ensure successful adoption of new program models and tools Additional Support and Responsibilities
• Assist in ad hoc projects and requests from internal and external customers Collaborate with the Patient Centered Medical Home program as needed and other TennCare initiatives and programs
• Provide oversight of THL coaching efforts by the MCOs -Track, review and evaluate engagement strategies and forums created by MCOs Communicate with MCOs to align on coaching for organizations and progress toward annual priority areas
• Provide oversight and guidance for MCO-hosted Delivery System Transformation conferences and webinars

Minimum Qualifications:

• A Bachelor's degree from an accredited college or university in public policy, health policy, public health, public administration, business administration or a related field and 3 years of experience in policy interpretation and application or similar work.

Or

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

Desirable Qualifications

• A master's degree in public health, healthcare administration, behavioral health or related field and 3+ years full-time professional experience in a healthcare setting or coordinating the implementation of health programs

OR

• A bachelor's degree in public health, healthcare administration, or related field and 5+ years full time professional experience in a healthcare setting or coordinating the implementation of health programs
• Demonstrated time management skills and proven ability to manage multiple tasks simultaneously while completing work within allocated time frames;
• Ability to balance and prioritize competing needs from internal and external stakeholders;
• Proficiency in Microsoft Office software including Word, Excel, and PowerPoint;
• Excellent communication, collaboration and presentation skills.
• Experience with health insurance, health care delivery, health policy, or value-based care;
• Knowledge of HEDIS measures and NCQA accreditation standards;
• Familiarity with existing community behavioral health clinic ecosystem in Tennessee.

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.