Digital Quality Specialist
State of Tennessee
Position Description / Responsibilities
Statistical Research Specialist
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 1.3 million Tennesseans and operates with an annual budget of approximately $12 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
WHY WORK AT TENNCARE?
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 work 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 AND DEPARTMENTAL OVERVIEW
The Quality Improvement Division is an integral team within the Chief Medical Office 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 Quality Improvement team operates the Patient Centered Medical Home (PCMH) program and Tennessee Health Link (THL) program. The THL and PCMH programs are the leading programs in TennCare’s primary care transformation initiatives supporting comprehensive care delivery and payment model innovation to improve the quality of primary care services for TennCare members and support population health of our primary care and primary mental health providers. TennCare provides a cloud-based population health technology platform called the Care Coordination Tool (CCT) to all PCMH and THL providers. The key functions of the CCT platform include the following:
Member attribution, patient demographic information, and panel management tools
Clinical risk stratification, and historical medical claims information
Admission, discharge, or transfer (ADT) data from hospitals and/or emergency rooms to allow real-time alerts to providers
Care gap identification linked to quality measures and tracking of care gap closure
Claims-based clinical data that provides clinical risk stratification and risk scoring for population health management
Digital Quality Specialist
This position leads the strategic development and execution of quality improvement initiatives through the use of population health technology tools, electronic health data, and digital applications to support TennCare’s quality strategy.
Responsibilities will include:
Oversee and lead all day-to-day operations for the Care Coordination Tool
Develop in-depth user knowledge of Care Coordination Tool capabilities and how to use all features provided by CCT
Coordinate all CCT education, onboarding, and training activities (e.g. webinars, training materials) for providers and staff participating in the Patient Centered Medical Home and Tennessee Health Link programs
Convene user groups to provide input on CCT enhancements and lead all provider change management efforts to inform on CCT updates and redesigns
Serve as QI lead liaison to TennCare’s Division of eHealth and external CCT vendor to manage timely business process and functionality improvements on an on-going basis
Communicate important Care Coordination Tool updates to providers, managed care staff, internal staff members, and other stakeholders via multiple channels
Assist in the design and development of future versions of the Care Coordination Tool
Lead the development of a TennCare digital quality strategy and explore creative technology-enabled opportunities to engage providers
Develop and implement a strategic plan for incorporating electronic clinical quality measures (eCQMs) and Electronic Clinical Data Systems into TennCare’s Quality Strategy
Identify strategic opportunities for EHR integration into MCO or TennCare quality improvement initiatives
Serve as liaison to internal and external stakeholders on digital or technology-enabled quality improvement tools such as telehealth, web and app-based solutions
Identify opportunities to deploy actionable data insights to providers electronically (e.g. ADT feeds, scaling CCT to additional providers, accessing state-wide registries)
Support Delivery System Transformation and Quality Measurement through integration of electronic data into provider reporting
Develop or maintain expertise on HEDIS metrics specification and measurement
Ensure accuracy in quality metric coding in the CCT and other provider-facing tools
Assist the PCMH Lead in managing the PCMH metric set, including re-thresholding and re-evaluating metrics
Attend provider conferences and regional collaboratives in Tennessee throughout the year to support provider engagement and education around digital quality
Keep apprised of new CMS opportunities or ONC requirements for electronic data and quality reporting (e.g. MACRA/MIPS, digital quality scorecards)
Other duties as assigned by the Quality Improvement Leadership Team
A master’s degree and 2+ years full time professional experience in a healthcare setting or coordinating the implementation of health programs
A bachelor’s degree and 5+ years full time professional experience in a healthcare setting or coordinating the implementation of health programs
In depth knowledge and user experience with population health software, care coordination platforms, and/or practice management through electronic medical records systems
Expertise in Microsoft Office software including Word, Excel, Outlook and PowerPoint
Experience in fast-paced and dynamic work environment
Strong organizational skills including the ability to prioritize multiple projects
Ability to be a self-starter, work independently, and collaborate with multiple stakeholders
Excellent communication and presentation skills
Experience with health insurance, health care delivery, health policy, or value-based payment
Experience with training individuals to use health information technology
Knowledge of primary care clinic workflows
Experience with calculating HEDIS or other claims-based health care quality measurements
Knowledge of basic medical billing and coding related to HEDIS measurement
Job Location: Nashville, Tennessee
Salary Range: Compensation arrangements are competitive and will be commensurate with the selected candidate’s experience and responsibilities of this position.
Position Status: Executive Service
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.
How to Apply: Qualified candidates should send a cover letter with salary expectations, resume, and writing sample to Rhonda.F.Fletcher@tn.gov by December 11, 2019.