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 (QI) Division, an integral team within the Medical Office, is responsible for monitoring, reporting, and leading innovative strategies to improve clinical quality and health outcomes for the members we serve. Operationally, the QI 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 quality initiatives that focus on transforming primary and behavioral health care delivery, supporting population health and prevention, and addressing social risk factors of 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 Digital Quality Product Manager leads the strategic implementation, execution, and oversight of technology tools, digital applications, and data sharing that directly support TennCare's quality improvement strategy. TennCare's technology suite includes a digital care management and risk stratification platform that supports provider practices in value-based care and a Closed Loop Referral System (CLRS) that connects members with resources provided by community-based organizations based on social risk factors identified at the health plan and provider levels. Both systems also coordinate data transfers amongst different stakeholders to support care gap closure and care coordination.
Key Responsibilities:
Care Coordination Tool (CCT) Design, Implementation and Maintenance
Review schedules specific to each partner for design and implementation of CCT. Actively participate in all planning meetings and ensure takeaways are addressed and resolved.
Work with CQO and supervisor to detail requirements listed in RFP. Identify any IT related requests and incorporate IS feedback as appropriate. -Identify potential risks and issues related to the CCT implementation and develop mitigation strategies to address them. Proactively communicate IT risks and proposed solutions to relevant stakeholders.
Develop and implement metrics to monitor the performance of the CCT. Regularly report on progress, challenges, and successes to senior leadership and stakeholders, providing data-driven insights to inform decision-making.
Testing and Training: Coordinate and oversee the CCT testing and training plans execution. Quality Product Strategy and General QI/DA Support
Serve as liaison to internal and external stakeholder on digital or technology-enabled quality improvement tools such as telehealth, web and app-based solutions.
Participate in and communicate with internal TennCare departments and workgroups to better understand TennCare IT data improvement projects, such as data ecosystem and collection of race and ethnicity data.
Meet with QI DA Director as needed to collaborate and stay up to date on data improvement projects.
Identify and attend conferences and educational opportunities hosted by external organizations to develop new skills/knowledge with which to enhance CCT and CLRS operations and long-term planning.
Attend at least three external conferences, webinars or educational opportunities to further knowledge and understanding of value-based payment, care coordination/SDOH platforms and Medicaid. IT Quality Product Daily Operations
Build and maintain strong relationships with the CCT vendor, managing vendor performance, and ensuring the delivery of high-quality IT services and support.
Foster a culture of continuous improvement by soliciting feedback from users and stakeholders, analyzing system performance, and implementing enhancements to optimize the CCT.
Oversee the communication and marketing efforts for the CCT to MCOs and other user groups as defined by the strategic rollout plans.
Provide necessary support to connect users with vendor technical assistance when needed.
Act as a primary point of contact, alongside the SDOH Director and PCQ Director for the CLRS and CCT vendor and stakeholders, including Managed Care Organizations (MCOs) for IT needs.
Effectively communicate TennCare's quality product and IT strategy, ensuring that all milestones and implementation steps are achieved.
Minimum Qualifications:
Bachelor's degree from an accredited college or university in related field (master's degree in health care field preferred
MBA, MPH, MPP, or MHA) AND 3+ years in similar role or 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
A master's degree or higher (Exceptional performance with 3+ years in similar role or in management/consulting will be considered in place of advanced degree)
In depth knowledge, user experience or implementation experience with population health software, care coordination platforms, electronic medical records systems, or other provider facing health technology platform.
Experience in managing projects, including planning, execution, and monitoring
Strong organizational, time management, analytical skills -Previous experience managing vendor relationships and performance
Ability to be a self-starter, work independently, and collaborate with multiple stakeholdrs
Ability to effectively communicate with both technical and non-technical stakeholders.
Excellent communication and presentation skills
Experience with health insurance, health care delivery, health policy, or value-based payment programs
Experience with training individuals to use health information technology
Knowledge of clinical and/or hospital workflows
Experience in managing projects, including planning, execution, monitoring, and evaluation
Experience working at or implementing EHR or other technology-enabled healthcare services products
Experience with calculating HEDIS or other claims-based health care quality measurements
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.
