ASSISTANT DIRECTOR FOR DSNP & PACE PROGRAMS - 71035

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:

Under supervision of the Director of CHOICES and Dual Eligible Operations and Initiatives, an employee in this position will lead contract management, data analytics, and oversight activities for the Program of All-Inclusive Care for the Elderly (PACE) and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). This role includes managing program oversight and reviews including federal compliance, audits, and strategic initiatives to improve care coordination, quality and program efficiencies for dual eligible populations. The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid. An interdisciplinary team of health professionals delivers coordinated care, enabling participants to remain in their communities rather than enter institutional care. D-SNPs, including Fully Integrated Dual Eligible (FIDE) SNPs, are designed to improve care quality and coordination for Full Benefit Dual Eligible (FBDE) individuals. These programs promote person-centered care planning and service delivery in the most integrated and cost-effective settings.

Key Responsibilities:

1. Lead monitoring and oversight of PACE services and quality of care, including on-site visits, data reviews, and audits. in drafting responses to inquiries and requests specific to TN experience and status.
2. Oversee collecting, analyzing, and interpreting data related to Medicare Improvement for Patients and Providers Act (MIPPA), FIDE, and D-SNP programs; track performance metrics and document program changes.
3. Draft responses to State and Federal inquiries and requests specific to TN experience and current and future status of assigned programs.
4. Identify and manage contract recommendations and implementations associated with current and future Program goals. Draft, review, and update protocols, policy and procedure documents for program changes.
5. Increase the number of dual eligible members enrolled in integrated and coordinated programs of care to improve quality of care and ensure cost-effective care delivery.
6. Facilitate, at minimum, monthly meetings with PACE to review and improve contract performance, compliance and quality.
7. Establish ways to resolve any issues and promote a collaborative approach with PACE staff.
8. Support Division initiatives to facilitate ongoing seamless conversion and dual eligible alignment activities and strengthen coordination requirements and processes across all health plans, as well as non-Medicaid D-SNPs.
9. Maintain and strengthen relationships and communication with stakeholders specific to the PACE and DSNP program.

Minimum Qualifications:

Bachelor's degree in a related field AND 3+ years in similar role or in health care management or services; experience interpreting policy or procedural provisions for a TennCare, Medicaid, or other related health insurance organization is preferred.

Experience in analyzing data and using data to drive performance and expectations. Experience with program management and/or grant management.

OR

An equivalent combination of education and work experience may be considered.

Desirable qualifications:

1. Graduation from an accredited college or university with a bachelor's degree.
2. Experience equivalent to two years of working with Medicare, DSNPs, or dual eligible populations.
3. Preferred experience with state Medicaid agency contracts (SMACs), CMS and federal regulatory framework.
4. Experience equivalent to two years of program or contract management, preferably in a healthcare or government setting.
5. Demonstrated ability to lead cross-functional teams and manage complex programmatic initiatives.
6. Excellent verbal and written communication skills.
7. Demonstrated ability to interpret and apply policy language, legislation, and regulatory guidance.
8. Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines.
9. Ability to adapt to changing priorities and deadlines.
10. Ability to exercise sound judgment and make appropriate recommendations.
11. Ability to analyze and summarize report and audit 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.