BHS RESEARCH AND POLICY LEAD - 76773

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. TennCare's Medical Office is integral to this mission by leading clinical quality and operations and strategic clinical innovation for the agency. Operationally, the medical office is comprised of 7 teams and 165 team members. The medical office is responsible for all medical, dental, behavioral health and pharmacy policy, operations, and appeals as well as quality improvement and population health programming.

The Behavioral Health Services team is an integral part of the TennCare Medical Office. This team leads efforts with provider partners, managed care organizations, and other key mental health and substance use disorder stakeholders to ensure statewide access and availability of behavioral health services. The team also designs and implements new treatment programs, ensures all BH services follow federal and state policies, and assesses the impact on the TennCare program. The team also monitors and works with the Managed Care Organizations (MCO) to assure compliance with the behavioral health standards contained within the TennCare contract. The BH Services team has end-to-end oversight of all mental health and substance use disorder benefits within the TennCare program, with an annual expense management of nearly $500 M. Behavioral Health Policy and Research Lead will report directly to the Deputy Director of BH Services and serves a critical role in managing the day-to-day operations within the Behavioral Health Services Team.

Key Responsibilities:

• Support Research and Policy Development for Behavioral Health Services
• Supports Behavioral Health Services in researching best practices and identifying emerging evidence to guide ongoing development of TennCare's behavioral health strategy.
• Leads project management for new initiatives, collaborating with team members to prepare workgroups, and presentations.
• Drives innovation and improve member outcomes by evaluating program effectiveness in partnership with the TennCare QI data analytics team.
• Supports development of grant proposals as applicable to leverage additional funding opportunities cultivating relationships with funders and community partners to enhance grant-seeking strategies in behavioral health services.
• Supports efforts to evaluate effectiveness of existing behavioral health services using a range of qualitative and quantitative review methods.
• Reviews and researches new federal or state regulations and partner with other states to identify emerging areas of development, compliance, and innovation to improve quality of BH care
• Other high-priority projects as assigned by the TennCare CMO or TennCare Director Lead Behavioral Health Policy Review and Compliance Oversight
• Collaborates closely with behavioral health and quality leadership within Managed Care Organizations to monitor and oversee the quality of behavioral health services.
• Analyzes existing quality metrics to identify opportunities for improving quality of behavioral health services for TennCare members.
• Reviews ongoing reports and data submissions from key stakeholders to ensure compliance with federal and state regulations and standards.
• Maintains policies and processes to monitor contractual compliance and review behavioral health deliverables and the execution of TennCare's requirements outlined in TennCare's MCO contracts.
• Participates in semi-annual MCO Contract reviews and supports development of updated contract language to strengthen oversight and compliance
• Contributes to the development and refinement of behavioral health policies and procedures
• Oversees behavioral health deliverables using information gathered to inform service delivery improvements and enhance quality of care. Foster Strong Relationships with Internal and External Stakeholders
• Works closely with other stakeholders as applicable ensuring coordination on statewide projects.
• Maintains contact with other related public health program staff to coordinate operations, functions, activities, and services.
• Works closely with professional organizations, providers, and other BH partners to ensure questions, concerns, and key updates are addressed in a timely manner.
• Supports educational efforts with community stakeholders by creating PowerPoint presentations, educational information, and updates needed to the TennCare behavioral health webpage as needed.

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

• Master's degree in epidemiology, public health, biostatistics, statistics, health informatics, or mental health professional services.

OR:

Education and Experience:

• Graduation from an accredited college or university with a master's degree in a health science field with experience equivalent to two years' work experience in epidemiology or behavioral health services.
• Strong, clear, and concise oral and written communication skills with the ability to craft clear and concise presentations
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
• Strong work ethic, professionalism, and ability to work well with a team.
• Innovative thinking and problem-solving skills and ability to adapt to changing priorities
• Experience with managed care operations and programs
• Experience with creating and writing grant proposals and policy
• Experience in project management, data analysis, or implementation of large-scale projects

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.