ASSISTANT DIRECTOR FOR DSNP & PACE PROGRAMS - 69221

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:

Under supervision of the Director of CHOICES and Dual Eligible Operations and Initiatives, an employee in this position will lead PACE and Dual Eligible contract management, data analytics, and oversight of audit and program reviews as necessary. 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 benefits. An interdisciplinary team of health professionals provides PACE participants with coordinated care. For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. With the Medicare Improvement for Patients and Providers Act (MIPPA), fully integrated dual eligible (FIDE), and Dual Special Needs Program (D-SNP) coordinate essential care to serve the Full Benefit Dual Eligible (FBDE) population in a manner that promotes improved quality of care, person-centered care planning, and delivery of services in the most integrated and cost-effective setting appropriate.

Key Responsibilities:

1. Manage and complete the review and developing criteria specific to monitoring services and quality of care to include on-site visits, data and audit reviews for the Program of All-Inclusive Care (PACE). in drafting responses to inquiries and requests specific to TN experience and status.
2. Responsible for collecting and analyzing reporting data associated with the Medicare Improvement for Patients and Providers Act (MIPPA), Fully integrated dual eligible (FIDE), and Dual Special Needs Program (D-SNP) to include but not limited to, reviewing current and new contracts and Federal rules regarding each program that are issues by CMS. Analyzing data, tracking progress, and documenting contract or program changes as needed.
3. Draft responses to State and Federal inquiries and requests specific to TN experience and current and future status of assigned programs.
4. dentify 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 progress dual eligible alignment activities and strengthen coordination requirements and processes across all three 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:

• Experience equivalent to two years of working with Medicare and DSNPs.
• Experience equivalent to two years of program or contract management.
• Excellent verbal and written communication skills.
• Experience in research and interpreting policy language and new legislation.
• Experience working in healthcare related fields -Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines.
• Ability to adapt to changing priorities and deadlines.
• Ability to exercise sound judgment and make appropriate recommendations.
• 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.