OUTPATIENT VALUE-BASED PROGRAM DIRECTOR - 68207

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 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 Quality Improvement Division is an integral team within the Medical Office that is responsible for monitoring, reporting, and leading innovative strategies focused on improving clinical quality and health outcomes. Operationally, the Quality Improvement 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 initiatives focused on improving clinical care and outcomes for TennCare members, including primary care transformation and population 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 Outpatient Value-Based Program Director will be a key leader on the Quality Improvement Team, reporting to the Chief Quality Officer. This position will guide and support enhancements for value-based payment programs for primary care, the Patient Centered Medical Home program and behavioral health, Tennessee Health Link program and other new strategic initiatives focused on outpatient clinical care integration and value-based approaches.

Key Responsibilities:

1. Lead strategic planning for TennCare's Value-Based Payment programs
2. Provide ongoing evaluation and innovation within TennCare's Patient Centered Medical Home and Tennessee Health Link to continually drive improvements in provider engagement, operational efficiency, and health outcomes
3. Lead executive VBP planning meetings with TennCare Senior Leadership to present key strategic decisions and programmatic considerations for action
4. Collaborate with the TennCare Data Analytics team to refine models and produce fiscal projections for VBP programs, Programmatic Tableau dashboards & other ad hoc analytics
5. Lead procurement and implementation for the Care Coordination Tool, the state's population health platform. Provide oversight and guidance for the CCT upgrades & enhancements, pilot CCT projects, & accuracy of data
6. Partner with TennCare clinical leadership to design & deploy new VBP initiatives (e.g. maternal health) that support clinical integration enhance primary & behavioral health quality improvement
7. Partner with Managed Care Organizations (MCOs) and other key external stakeholders to execute TennCare's Value-Based Payment Strategy
8. Lead collaborative efforts with MCOs, providers, and key stakeholder groups such as providers, to scale best practices for PCMH and THL program participants
9. Engage with program participants across the state to discuss program recommendations, concerns, or strategies for success
10. Partner closely with MCOs to support and implement key programmatic or policy changes to value-based payment programs and advanced payment models.
11. Develop solutions, ensure timely updates, and manage communications across stakeholders to solve operational issues.
12. Identify opportunities for TennCare alignment with national or all-payer VBP models in primary care, behavioral health, and outpatient clinical care integration.
13. Lead and manage the Primary Care Quality team
14. Maintain current and develop new relevant stakeholder relationships through serving as the TennCare POC for workgroup meetings and engagement in collaborative projects as needed with organizations/committees
15. Partner on collaborative cross-functional quality initiatives such as social determinants of health, digital quality measurement, maternal and specialty care to drive improvements in outpatient care delivery
16. Assist with or lead ad-hoc projects and requests from the Chief Medical Office or Chief Quality Officer as necessary
17. Provide ongoing feedback and guidance through weekly check-in meetings with each direct report (Approximately 4 direct reports)
18. Assist team in growth and development goals

Minimum Qualifications:

Bachelor's degree from an accredited college or university in related field (master's degree in health care related field highly preferred - MBA, MPH, MPP, or MHA) AND 5+ years 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 (MBA, MPH, MPP, MHA) or higher (Exceptional performance with 3+ years in similar role or in management/consulting will be considered in place of advanced degree)

Advanced Proficiency in Microsoft Office including Word, Excel, and PowerPoint

Highly developed interpersonal, oral, presentation, and written communication skills

Strong analytical, strategic thinking, organizational, and time management skills

Experience with value-based care, healthcare delivery, health policy, or healthcare payer experience preferred

Ability to work independently and collaborate and communicate with a variety of stakeholders

Experience in project management

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.