TennCare Medicaid Informatics Director

TennCare Medicaid Informatics Director

TENNCARE OVERVIEW

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 TennCare Medicaid Informatics Director (TCMID) is responsible for the direction and oversight of the HealthCare Informatics section and for the leading the execution of TennCare’s data analytics strategy. The HealthCare Informatics (HCI) unit is responsible for extracting and analyzing healthcare data to help inform key fiscal and clinical quality policy decisions that impact TennCare’s 1.4 million members; the enrollees in programs of the Department of Intellectual and Developmental Disabilities (DIDD); and Medicaid-funded service recipients in the Department of Children’s Services (DCS). This encompasses annual expenses in excess of $12 billion. The division is also tasked with creating databases, reports, and developing processes to integrate programs into the existing data structure. Daily activities include leading design and implementation decisions on analytics strategy, conducting direct cost and utilization analyses related to actuarial rate setting, population risk assessment, enrollment and financial projection, benefit design, program performance evaluation, and activities of data mining surveillance/utilization to detect abnormal patterns and potential fraud.

RESPONSIBILITIES

Reporting directly to the Chief Financial Officer of TennCare, this Director will be responsible for providing decision support data for the entire Medicaid-funded program in the State of Tennessee. The position will manage a team of analysts to produce standard and ad hoc reports to drive financial decisions, support strategic initiatives, and respond to data requests from internal and external stakeholders. The analysis work required with respect to these responsibilities is of considerable complexity and requires significant expertise in econometric modeling to identify statistically significant correlations in the claim data and communicate those findings to a broader audience. This Director will also collaborate with multiple executive team members on high priority projects.

Specifically, primary duties of the TennCare Medicaid Informatics Director will include:

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• Design and lead the implementation of an agency-wide strategy to establish and support an increased analytics capacity both within the HCI unit and in selected other areas in a coordinated way, with a goal of increasing access to and utilization of data for decision-making.
• Partner with TennCare executive leadership to execute strategic TennCare program priorities which include but are not limited to: trending and analyzing health outcomes data (e.g. HEDIS), evaluating delivery-system transformation program impact, measuring long-term supports and services performance, supporting legislative and budget fiscal analysis, and developing data visualization opportunities.
• Provide strategic direction and oversight of the Decision Support System/Data Warehouse and IT&S data/reporting quality control activities which include key performance indicators for clinical, population health, financial and eligibility outcomes.
• Oversee the ongoing management of a data warehouse project, including developing the schematics for data warehouse design to assist the state’s Medicaid Management Information Systems vendor in developing database tables that would support an improved data management and extraction interface.
• Help develop the data architecture for the Agency via taking a leadership position with the Data Governance committee. In addition, helping shape the strategy and architecture of a future enterprise data warehouse. Outstanding candidates will have a working knowledge of innovative data warehouse technologies.
• Provide direct oversight and management of the Surveillance/Utilization Review (SUR) unit which performs data mining activities to detect patterns of Medicaid providers and members based on user-defined parameters and other criteria which can detect abnormal patterns and potential fraud. SUR staff identify aberrant behaviors; conduct hospital, physician and other provider type audits to educate providers on program guidelines; and recover inappropriately reimbursed funds.
• Work jointly with a variety of regulatory agencies that include but are not limited to the Medicaid Fraud Control Unit (MFCU), the TBI, the Office of Inspector General (OIG) and Office of Attorney General (OAG). The unit is the focal point for TennCare fraud data collection and reporting; this activity includes data collection and reporting for the
• Federal Centers for Medicaid Services Office (CMS) and the Managed Care Organizations (MCOs).
• Work with State and Federal Officials, Legal Staff, Courts, Law Enforcement Officials, and the TBI with the identification, investigation and prosecution of fraud and abuse cases.

MINIMUM QUALIFICATIONS

Outstanding candidates will have experience leading data collection and analysis in managed care organizations. They will be experts in defining and implementing reporting models at scale. They will be results-oriented and customer focused, with a bias for action. They will also be able to think strategically and foresee implications for TennCare that may arise from changes in the healthcare macro-economy. They will be a strong and experienced manager of people, able to inspire a team and interact as a peer with internal stakeholders as well as representatives from large payer and provider organizations. They will be flexible and team-oriented, with a strong desire to collaborate with others and develop their team.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• A master’s degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 2+ years full time professional work developing research methodology and/or directing statistical research

– OR –

A bachelor’s degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 5+ years full time professional work developing research methodology and/or directing statistical research

• 2+ years’ experience statistical and analytical experience using tools such as SAS and/or SQL
• Strong computer skills including mastery of Microsoft Office applications such as Excel, Access, Word, and Power Point, as well as statistical software applications
• Strong, clear, and concise oral and written communication skills
• Strong organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
• Experience in Tableau or related data visualization software
• Experience completing complex analyses accurately under time pressure, and in communicating the results of those analyses in plain language to senior leaders
• Expertise in working effectively with outside vendors

DESIRABLE QUALIFICATIONS

• Experience working in or with Medicaid or disability related programs
• Strong work ethic and self-motivated 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 deadline

SALARY

Compensation arrangements are competitive and will be commensurate with the selected candidate’s experience and achievements, and responsibilities of this position.

JOB LOCATION: Nashville, Tennessee

HOW TO APPLY: Qualified candidates should send a cover letter with salary expectations, resume, and writing sample by December 23, 2019.

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.

Job Type: Full-time

Experience:

• research methodology and/or directing statistical research: 5 years (Required)
• Tableau or related data visualization software: 1 year (Required)
• SAS and/or SQL: 2 years (Required)

Education:

• Bachelor’s (Required)