TENNCARE DENTAL OPERATIONS LEAD – 61456

Executive Service

TennCare Dental Operations Lead

Division of TennCare

Chief Medical Office (CMO)

Nashville, TN

Salary: Minimum Monthly Salary $6,479/month TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

Closing Date: 10/07/2024

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:

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system reform. Operationally, the TennCare Dental Team is responsible for leading the dental strategy and overseeing all operations of TennCare’s dental benefits for all adult and child TennCare and CoverKids members. The Dental Team provides oversight of the contract with the Dental Benefits Manager (DBM) to ensure members receive high quality, cost-effective dental care. The Dental Team also ensures the dental program is in compliance with federal and state requirements. requirements. 

Additionally, the Dental Team works closely with other TennCare divisions to improve member access and utilization, and integrated whole-person health to achieve better oral and overall health outcomes for TennCare members. The TennCare Dental Team serves as an important liaison between external dental stakeholders and other agencies in support of efficient delivery of dental services for TennCare members. Through these vital partnerships with the dental community and stakeholders, TennCare Dental leads strategic clinical initiatives and quality improvement not only for TennCare members but across the state. The Dental Operations Lead, reporting directly to the TennCare Chief Dental Officer, plays an integral role in the success and oversight of the dental program. The Dental Operations Lead will ensure strong ongoing operations and oversight of the TennCare Dental Benefits Manager, partner with stakeholders to lead quality improvement initiatives, and support review and compliance with key policies and regulations.

Key Responsibilities:

• Support Operations and Contract Oversight of TennCare’s DBM to Ensure Access to and Delivery of Dental Services to TennCare Members 
• Manage contract compliance by ensuring timely deliverable tracking and data reports. 
• Synthesize information to identify opportunities for improvement and increased visibility 
• Utilize project management skills to ensure timelines for high-priority analytics or strategic initiatives are completed accurately and timely 
• Collaborate closely with DBM to advance Patient Centered Dental Home strategy through deliverable design, review, and improvement initiatives 
• Design oversight processes to monitor DBM member engagement and care coordination supports 
• Support design and development of new TennCare dental initiatives. 
• Coordinate with teams to implement new processes. 
• Partner with Provider Networks to monitor and ensure the dental networks meet contractual standards on regular cadence 
• Review state and federal rules changes and develop new oversight processes to ensure compliance with all requirements as needed 
• Develop new templates or reports to support contractual compliance as required for contracted vendors supporting delivery of dental services 
• Partner with the TennCare Dental and other Medical Office Teams to Support Strategic Projects and Lead Integrated Programs to Deliver Improved Care 
• Analyze key dental outcomes and reporting to partner with TennCare Medical Office leadership to develop process and quality improvement opportunities
• Support the Quality Improvement team on EPSDT and early childhood oral health services focused on increasing dental preventative service utilization 
• Track achievement of all dental quality targets, goals and metrics, and design quality improvement and innovative initiatives to drive improvement on care delivered
• Support TennCare Dental team members to execute TennCare dental strategy and ensure efficient and effective management of the TennCare dental program 
• Foster strong, collaborative team culture and invest in professional growth and development 
• Research emerging best practices to identify potential new opportunities to leverage within TennCare dental programs 
• Support continued TennCare integration of the IDD dental program 
• Lead special projects as otherwise assigned by the Chief Dental Office 
• Foster Strong Relationships with Community Stakeholders and Dental Providers
• Serve as a liaison with the DBM administrative and professional staff to provide education on TennCare policy and programs 
• Support key provider stakeholders, such as TDA, Pan-TDA, TPCA, TDAC, TNAAP and other stakeholders and partners related to cost and quality of dental care
• Foster strong relationships with TennCare contracted dental providers or provider organizations through outreach and responsive communications 
• Monitor member engagement, member satisfaction surveys, and dental utilization. 
• Respond timely to professional organizations to ensure questions, concerns and key updates are addressed in a timely manner

Minimum Qualifications:

Bachelor’s degree from an accredited college or university in related field (master’s degree in health care related field highly preferred – MBA, MPH, MPP, or MHA) AND 5+ years in health care management or operations. Experience interpreting policy or procedural provisions for a related health insurance or provider 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: 

• Proficiency in Microsoft Office software including Word, Excel, and PowerPoint 
• Experience in project management, data analysis, or implementation of large-scale projects 
• Strong organizational, time management, analytical skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines 
• Innovative thinking and problem-solving skills and ability to adapt to changing priorities Desirable qualifications cont. 
• Experience or certifications in quality improvement or lean six sigma
• Experience with population health or value-based payment reforms
• Experience with population health or value-based payment reforms 
• Experience with managed care operations and programs 
• Excellent communication, collaborative and presentation skills

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.

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