LONG TERM SERVICES SUPPORT (LTSS) DIRECTOR OF CHOICES AND DUAL ELIGIBLE OPERATIONS AND INITIATIVES - 63881

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.

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 Assistant Deputy of Programs, an employee in this position will serve as Director of CHOICES and Dual Eligible Operations. TennCare CHOICES in Long-Term Services and Supports (or CHOICES for short) is for adults (age 21 and older) with a physical disability and seniors (age 65 and older).

CHOICES offers services to help a person live in their own home or in the community. These services are called Home and Community Based Services or HCBS. These services can be provided in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in their local community. If needed, CHOICES also provides care in a nursing home. This role ensures that programs meet federal and state regulatory requirements, promote health equity, and deliver high-quality, cost-effective care to vulnerable populations. The Director collaborates with internal and external stakeholders to develop innovative solutions, drive program improvements, and achieve financial and operational goals.

This individual will also be responsible for overseeing and managing programs specifically focused on dual eligibles (individuals both eligible for Medicaid (TennCare) and Medicare): The Program of All-Inclusive Care for the Elderly (PACE) and Dual Special Needs Programs (DSNPs).

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.

Dual-Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare and Medicaid with the goal of aligning services and benefits and improving coordination and quality of care to members.

The successful candidate will be responsible for managing the programs, reporting, contracts, performance, policies, and other activities for CHOICES, D-SNP, and PACE programs.

Key Responsibilities:

• Responsible for overall management and direction of the CHOICES and PACE programs as well as DSNPs. Oversight of the State's three contracted MCOs, the fiscal employer agent (FEA)and collaboration with other state agencies, including interagency agreements and grant contracts related to program operations. This includes all activities related to contract management to ensure the contractors are achieving intended outcomes and meeting program expectations, including contractor accountability when requirements are not met.
• Manage the monitoring of services and quality of care through thorough review and understanding of data and audits for programs. This includes regularly reviewing and updating report elements to accurately capture and trend performance. Use reports to provide analysis regarding services provided and satisfaction of services and drive process improvement.
• 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. Support the furthering of duals initiatives and dual demonstration initiatives.
• Exhibit excellent collaboration and customer service by promptly and accurately addressing questions and complaints from, or related to, MCOs, AAADs and other stakeholders related to the CHOICES, PACE, and D-SNP programs. This will include regular contact with MCOs, AAADs, Community Living Supports Ombudsman and other advocates and stakeholders.
• Lead the management of the nursing facility program, in close collaboration with Health Facilities Commission and CMS, to include audits, tracking of deficiency notices and closure processes.
• Oversee the creation and revision of policies, procedures, and protocols related to the CHOICES, PACE, and DSNP programs. Conduct regular review of program rules, regulations, data and quality metrics and make recommendations for changes/improvements, as well as research practices in other states and maintain expertise in national best practices related to MLTSS programs for individuals served.
• Conduct presentations and training as assigned and serve as Subject Matter Expert for these programs.
• Other special projects as assigned.

Minimum Qualifications:

• Graduation from an accredited college or university with a Bachelor of Science degree and at least 3+ years' experience in program management, healthcare, or working with older adults, or adults with physical disabilities.
• 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

OR

• an equivalent combination of education and work experience may be considered

Desirable qualifications:

• Experience with program management and/or grant management
• Strong written and oral communication skills
• Experience supporting the elderly, and/or those with physical disabilities, person-centered practices, and integrated employment and community living
• Experience working in or with Medicaid or disability related programs
• Experience working with Medicare and D-SNPs
• Strong work ethic and self-motived with ability to work well on a team
• 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

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.