PROVIDER EXPERIENCE DIRECTOR - 71251

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:

Operationally, the Provider Services (PS) Division works closely with existing healthcare providers as well as healthcare providers seeking to newly enroll with TennCare. The Provider Services Division is responsible for screening, enrollment, credentialing, monitoring, reporting, and activities designed to streamline provider participation processes. Additionally, the PS Division works closely with the TennCare Managed Care Contractors (MCCs) ensuring MCCs have accurate information to contract with providers and that each MCC maintains robust provider networks to ensure 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 Experience Director will be a key leader on the Provider Services management team collaborating with the Director of Provider Services and the Chief Medical Office to oversee strategic plans by both TennCare and the MCCs to engage medical, behavioral, dental and pharmacy providers. The Provider Experience Director will oversee the integration of data tracking to support evaluation and performance improvement across all Provider Services business processes to drive improvement in efficiency and quality of data in support of TennCare initiatives. This will include strategies to improve provider network adequacy and validation. The Provider Experience Director is responsible for the overall coordination of efforts within the provider experience division to include planning, directing, organizing, and evaluating the implementation of strategic plans that will ensure provider interactions with TennCare are positive and effective. The Provider Experience Director works closely with MCCs to establish strong relationships to advance their partnership in service to TennCare members. This position works closely with external and internal stakeholders to oversee provider enrollment, education, and network monitoring activities.

Key Responsibilities:

1. Directly lead and have primary accountability for the TennCare provider experience.
2. Develop, implement, and coordinate a comprehensive provider engagement strategy across the TennCare medical office that supports proactive communication and outreach to TennCare providers.
3. Develop and maintain positive, long-term relationships with physicians, healthcare providers and healthcare systems to support and improve relationships with TennCare and its MCCs.
4. Coordinate with key TennCare teams and MCCs to ensure efficient and high-quality transfer of necessary provider information and education materials.
5. Identify new best practices and opportunities for continued advancement and evolution of a provider-friendly experience with TennCare.
6. Function as a Provider Representative for the Division of TennCare to external stakeholders.
7. Provide exceptional customer service and collaborate effectively with internal and external stakeholders to problem-solve provider issues and develop systemic solutions.
8. Lead cross-functional efforts with TennCare and its MCCs to resolve high-priority individual medical care issues for providers and/or members to ensure appropriate care is delivered.
9. Analyze provider engagement strength and opportunities.
10. Identify systemic solutions to proactively address operational challenges that may be leading to inefficient provider processes or negatively impacting provider experience.
11. Lead project management and develop reporting mechanisms to track successes, and opportunities for improvement related to provider experience.
12. Identify efficient solutions and respond timely to provider information requests submitted to TennCare through emails, call centers, legislators, or other communication channels Support the enhancement of member access and provider experience by reducing ghost provider networks by improved oversight of MCC network adequacy and validation.
13. Develop and implement strategy to integrate data validation and efficiency processes into team workflow.
14. Collaborate with Provider Services leadership and the MCCs to improve provider data accuracy in support of improved network analyses.
15. Develop targeted engagement plans for inactive providers to encourage increased participation and utilization within the network.
16. Identify and research national best practices to leverage across the TennCare program.

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:

1. Strong, clear, and concise oral and written communication skills, including extensive experience in public speaking and developing engaging presentations.
2. Strong interpersonal communication and customer services skills.
3. Strong proficiency in Microsoft Office Software (Excel, Access, Word, and PowerPoint).
4. Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
5. Prior experience leading and managing teams and direct reports.
6. Master's degree in health care administration, public health, business administration, communications, or related field.
7. Experience in project management and data analysis.
8. Strong experience in a heavily audited environment or in direct health care operation.

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.