MANAGED CARE DIVISION DIRECTOR - EXECUTIVE

State of Tennessee

Nashville, TN

Health Care , Customer Service


Position Description / Responsibilities

JOB AND DEPARTMENTAL OVERVIEW

Operationally, the Provider Services (PS) Division works closely with existing healthcare providers and healthcare providers seeking to enroll in 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. Each MCC maintains robust provider networks to provide access to care for TennCare members. The PS Division is focused on better-supporting TennCare providers' experiences and responding to provider issues that may complicate a providers' ability to treat eligible TennCare members and receive appropriate payment for those services.

The Provider Experience Manager position will be a key leader on the Provider Services management team reporting directly to Provider Services' Director. The Provider Experience Manager is responsible for the overall coordination of efforts within the PS Division of the Chief Medical Office to include planning, directing, organizing, and evaluating the implementation of strategic plans that will ensure provider interactions with TennCare are positive and effective. This position works as part of a team whose primary function is to oversee provider enrollment, screening, and network monitoring activities.

RESPONSIBILITIES

• Directly lead and have primary accountability for the TennCare provider experience

• Develop, implement, and coordinate a comprehensive provider engagement strategy across the TennCare medical office that supports proactive communication and outreach to TennCare providers

• Provide management and oversight of Provider Registration, Credentialing and Network monitoring activities within the Provider Services Division

• Develop positive, long-term relationships with physicians, healthcare providers and healthcare systems to support and improve relationships with TennCare and its MCCs

• Coordinate with key TennCare teams and MCCs to ensure efficient and high-quality transfer of necessary provider information and education materials

• Identify new best practices and opportunities for continued advancement and evolution of a provider-friendly experience with TennCare

• Function as a Provider Representative for the Division of TennCare to external stakeholders

• Provide exceptional customer service and collaborate effectively with internal and external stakeholders to problem-solve provider issues and develop systemic solutions

• 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

• Identify systemic solutions to proactively address operational challenges that may be leading to inefficient provider processes or negatively impacting provider experience

• Foster professional working relationships with key professional organizations (TNAAP, TMA, THA, TPA, etc.) to provide training on common provider mistakes

• Lead project management and develop reporting mechanisms to track resolutions

• Receive and respond to provider information requests submitted through the Tenn.Care@tn.gov email box

• Support the Provider Services Division and other Medical Office initiatives to strengthen relationships and improve TennCare Provider experience

• Foster professional working relationships with TennCare Chief Medical Office Divisions by participating in planning provider engagement related activities for each CMO Division

• Collaborate on high priority TennCare provider initiatives across the Medical Office to support building high-quality provider networks (e.g., TennCare Patient-Centered Medical Homes, TN Health Link, Buprenorphine Enhanced & Supportive Medication-Assisted Recovery and Treatment Program (BESMART) Network)

• Assist with the professional development of Provider Services and other Medical Office teams to improve provider interactions


Position Requirements

MINIMUM QUALIFICATIONS

• A Bachelor's Degree in a health-related field, public policy, communications, or business administration

• 5+ years full-time professional working directly with health care providers, health care systems, or managed care organizations

• Excellent oral and written communication skills, including extensive experience in public speaking and developing engaging presentations

• Strong interpersonal communication and customer services skills

• Proficiency in Microsoft Office Software (Excel, Access, Word, and PowerPoint)

• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines

• Prior experience leading and managing teams and direct reports


Application Instructions

Apply Here: TN.gov/Careers

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