Executive Service
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 compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.
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.
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 (QI) is an integral team within the Chief Medical Office (CMO) that is responsible for monitoring, reporting, and leading innovative strategies focused on improving clinical quality and health outcomes. The QI Data Analytics (DA) team leads key reporting, evaluation, and strategic analysis across the agency for all quality-related initiatives. Within QI, the Data Analytics team leads all analytic efforts for QI units including the Population Health Team, Social Determinants of Health Team, and the Primary Care Quality team focused on value-based outpatient programs. Additionally, the DA team collaborates closely with all other teams within CMO, including Dental, Pharmacy, Behavioral Health, and Appeals teams to provide analytics and dashboarding expertise. Externally, the QI division works closely with TennCare's contracted organizations and other state agencies to provide oversight of quality performance and data reporting for TennCare Members. This position will be a key member of the QI Data Analytics team reporting to the QI Data Analytics Director. This position will support data analytics for TennCare's Rural Health Transformation initiatives.
Key Responsibilities:
Provide analytics/data expertise for CMO teams and for TennCare Value Based Payment (VBP) programs
Utilize knowledge of claims data to identify key trends/insights to inform CMO leadership decisions on key clinical areas/outcomes
Develop strategies/methodologies for completing complex data requests
Assist in the creation of new VBPs, participate in meetings, and provide data/quality measure expertise
Create technical specifications for measures
Code/calculate quality metrics using claims data and provide analysis comparisons as requested
Evaluate quality measures at the individual provider or aggregate level using relevant information, individual judgement, and measure specifications
Run annual CMS Core Measures, including stratifications by MCO and Region
Research external data sources, including Medicare data, to be included in CMS Core Measures for Mandatory reporting
Query, collect, prepare, and safeguard data, and produce key deliverables to satisfy CMS, legislative, and other ad-hoc requests -Support high priority legislative reporting at request of CMO and TennCare leadership
Provide analytics expertise to review and summarize complex reports
Perform quality checks of data and reports provided by MCOs and collaborate with the MCOs, as needed, for timely report completion
Develop advanced analytic approaches using multiple complex databases to develop comprehensive health outcome measurements stratified by providers, hospitals, MCOs
Partner with clinical data leads to support development of TennCare quality strategy
Participate in the design/development of the QI dashboards
Partner with other CMO teams to explore and utilize data specific to each team -Provide technical assistance/training to new analysts including providing claims data knowledge, answering technical questions, and reviewing projects to provide feedback on ways to make things more efficient
Design/develop dashboards for CMO teams to highlight projects and initiatives
Meet with teams to understand the ask and to present the final dashboard
Develop methodology for pulling and/or aggregating data
Design dashboards to meet the expectations of the CMO team and DA design standards
Assist on Data Ecosystem related items including providing expertise in meetings with the DE contractor
Ensure methodology and data sources are correct
Develop expert level knowledge of the data sources and how they are used for the various projects
Minimum Qualifications:
Requires a Bachelor's degree in a quantitative or related discipline (i.e., statistics, applied statistics, mathematics, biostatistics, economics, epidemiology, computer science, social or behavioral sciences, health sciences, business, business administration, public administration, public policy, or other related field) AND 5 or more years of relevant professional work experience.
OR
A Master's degree in a quantitative or related discipline AND 1-2 or more years of relevant professional work experience. OR 10 or more years of relevant professional work experience.
DESIRABLE QUALIFICATIONS
A Master's Degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 4+ years full time professional work developing research methodology and/or directing statistical research -OR- -A Bachelor's Degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 6+ years full time professional work developing research methodology and/or directing statistical research -4+ years of statistical and analytical experience using SAS and/or SQL.
Strong computer skills including mastery of Microsoft (Excel, Access, Word, and PowerPoint) as well as statistical software applications (SAS, R, Python, etc.)
Strong, clear, and concise oral and written communication skills -Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
Experience in Tableau or Power BI
Experience in other visualization software
Experience in healthcare field and/or with quality measurement
Experience in survey development and analysis
Experience working with hospital data
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.
