PROVIDER ENGAGEMENT LEAD - 76314

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 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 works closely with existing healthcare providers as well as healthcare providers seeking to newly enroll with TennCare and guiding activities designed to streamline provider participation processes. Additionally, the PS Division works closely with the TennCare Managed Care Contractors (MCCs) ensuring maintain robust provider networks providing 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 Engagement (PE) Lead will be a key leader in the PS Division collaborating with the Provider Experience Manager and Provider Experience Director to oversee strategic plans by both TennCare and the MCCs that engage medical, behavioral, dental and pharmacy providers. The PE Lead plans, directs, organizes, and evaluates the implementation of strategic plans that will ensure provider interactions with TennCare are positive and effective. The Lead will work closely with internal and external stakeholders to execute the provider engagement strategy including opportunities for provider education enhancing the TennCare provider and member experience.

Key Responsibilities:

• Operationalize and oversee a coordinated TennCare provider engagement strategy:
• Coordinate with key TennCare teams and MCCs to ensure efficient, impactful interactions with providers.
• Identify best practices and opportunities for advancement and evolution of a provider-friendly experience with TennCare
• Function as a Provider Representative to external stakeholders by contributing to town hall meetings, site visits, and expositions.
• Lead project management and develop reporting mechanisms to track timelines, delegate tasks, and improve processes related to provider experience Support the Provider Services Division and other Medical Office initiatives to strengthen relationships and improve the TennCare Provider experience
• Foster professional working relationships with TennCare Chief Medical Office (CMO) Divisions by participating in planning provider experience related activities
• Collaborate with Provider Enrollment and Networks teams as they roll out updated processes for enrollment and network monitoring and reporting.
• Assist with professional development of Provider Services and other CMO teams
• Develop creative solutions to address provider challenges related to Medicaid enrollment.
• Facilitate cross-functional teams and provide leadership over tasks with uncertain scope and diverse stakeholders, including, but not limited to, managed care contractors, CMO leadership, providers, and other TennCare units.
• Research and present national best practices and policy/regulatory changes pertaining to Medicaid provider engagement.
• Develop new processes, procedures, and informational collateral that contribute to TennCare's overall provider engagement strategy:
• Work closely under the leadership of the Provider Experience Manager to develop and implement processes to use data to enact targeted outreach to providers
• Track and measure provider outreach methods to ensure efforts improve member engagement and escalate systemic issues to appropriate TennCare teams.
• Monitor provider engagement data and prepare regular reports for Provider Services and CMO leadership.
• Collaborate with other TennCare divisions to ensure a comprehensive, provider-centric approach to provider engagement.
• Conduct needs assessments to inform future efforts and meet the needs of TennCare providers.
• Collaborate with MCC partners to identify and monitor areas for improvement within provider engagement activities.
• Partner with PS senior leadership on additional projects to advance TennCare Provider Experience strategy as assigned

Minimum Qualifications:

Education and Experience:

• Graduation from an accredited college or university with a bachelor's degree and experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization, of which one year must include drafting contractual requirements, developing rules and regulations, or supervising professional staff who deal with health insurance.

Substitution of Experience for Education:

• Qualifying professional experience interpreting policy or procedural provisions for a related health insurance organization may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).

OR

• Four years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, and/or Managed Care Division Director with the State of Tennessee, of which one year must be at the Managed Care Specialist 3 or higher level.
• A bachelor's degree in a health-related field, public policy, communications or business administration
• 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, PowerPoint, Teams, and SharePoint)
• 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 -35+ years of experience in provider enrollment, credentialing, or a managed care setting
• 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.