Managed Care Division Director - 55286

Executive Service

MANAGED CARE DIVISION DIRECTOR

Division of TennCare

Nashville, TN

Minimum Monthly Salary $5,508/month

Closing Date: 3/11/2024

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.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.

TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

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:

Operationally, the Provider Services (PS) Division works closely with existing healthcare providers as well as healthcare providers seeking to newly enroll with TennCare. The Provider Services Division is responsible for screening, enrollment, credentialing, monitoring, reporting, and activities designed to streamline provider participation processes. Additionally, the PS Division works closely with the TennCare Managed Care Contractors (MCCs) ensuring MCCs have accurate information to contract with providers and that each MCC maintains robust provider networks to ensure access to care for TennCare members. The PS Division is committed to engaging TennCare providers to help optimize their experiences serving TennCare members.

The Provider Experience Director will be a key leader on the Provider Services management team collaborating with the Director of Provider Services and the Chief Medical Office to oversee strategic plans by both TennCare and the MCCs to engage medical, behavioral, dental and pharmacy providers. The Provider Experience Director is responsible for the overall coordination of efforts within the provider experience division to include planning, directing, organizing, and evaluating the implementation of strategic plans that will ensure provider interactions with TennCare are positive and effective. The Provider Experience Director 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 provider enrollment, education, and network monitoring activities.

Key Responsibilities:

• Directly lead and have primary accountability for the TennCare provider experience
• Provide exceptional customer service and collaborate effectively with internal and external stakeholders to problem-solve provider issues and develop systemic solutions
• Support the Provider Services Division and other Medical Office initiatives to strengthen relationships and improve TennCare Provider experience
• Engage with local providers across the state and represent TennCare nationally in forums focused on improving provider relationships and provider education

Minimum Qualifications:

• A Bachelor's Degree in a health-related field, public policy, communications or business administration
• 5+ years full time professional working directly with health care providers, health care systems, or MANAGED CARE organizations
• Strong, clear, and concise oral and written communication skills, including extensive experience in public speaking and developing engaging presentations
• Strong interpersonal communication and customer services skills
• Strong proficiency in Microsoft Office Software (Excel, Access, Word, and PowerPoint)
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines
• Prior experience leading and managing teams and direct reports

Desirable Qualifications:

• Master's degree in health care administration, public health, business administration, communications, or related field
• Certifications in lean six sigma or quality improvement
• Experience in project management and data analysis
• 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.