CHIEF QUALITY OFFICER - 72521

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 criminal 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 payment reform. The Quality Improvement (QI) Division is an integral team within the Medical Office that is responsible for monitoring, reporting, and leading innovative strategies focused on improving clinical quality and health outcomes. Operationally, QI works closely with multiple TennCare divisions to lead the development and execution of a comprehensive quality strategy. Additionally, QI plays a strategic role in TennCare initiatives focused on improving clinical care and outcomes for TennCare members, including primary care transformation, population health, and addressing member's health related social needs. Externally, the Quality Improvement Division partners with TennCare's Managed Care Contractors (MCC), multiple state agencies, and key community and provider partners to implement quality initiatives and lead innovate care models. QI also leads data reporting, analytics, and dashboarding for TennCare members to drive clinical insights for improvement and meet all state and federal reporting requirements. The Chief Quality Officer (CQO) directly oversees and is accountable for the entire Quality Improvement Team, reporting directly to the TennCare Chief Medical Officer. The CQO will also be responsible for designing and implementing TennCare's Quality Improvement Strategy and serve as representative to key external stakeholders in deploying the strategy. The CQO is a key senior staff leader for TennCare.

Key Responsibilities:

Provide leadership and direct management for each QI team to execute TennCare's comprehensive quality strategy and ensure accountability for work products. Responsibilities for each team include:

• Population Health Team
• develops population health strategies and clinical initiatives for targeted patient population groups, and leads implementation with key stakeholders providing services to TennCare Members -Data Analytics Team
• leverages data and analytics to provide insights on areas for quality improvement as well as meet quality reporting requirements
• Primary Care Quality Team
• manages the ongoing operations of TennCare's value-based payment programs including Patient Centered Medical Homes (PCMH) and Tennessee Health Link (THL), serve as business owner for the Care Coordination Tool (CCT) -Social Determinants of Health (SDOH) Team
• leads TennCare's Health Starts Initiative that encompasses all efforts to address health related SDOH, and strengthen the nontraditional healthcare workforce Lead and oversee Managed Care Contractors and other key contractors to assure QI responsibilities and deliverables are met timely and strategically.

Responsibilities include:

• Support TennCare competitive procurement and grant processes to establish clear contract requirements and deliverables to support quality strategy and required activities
• Provide executive management of key contractors (TennCare External Quality Review Organization (EQRO), TN Community Compass CLRS contract, Care Coordination Tool, PCMH Accreditation) to provide strategic alignment and effective contract performance
• Develop strong relationships with key clinical and quality leads to foster collaboration and accountability to advance TennCare quality priorities
• Coordinate with other TennCare Divisions quality monitoring and reporting activities of MCC and contracted agencies and develop corrective action plans as needed. Foster an agency-wide focus for TennCare on quality and cultivate a collegial, team-based workplace culture to support ongoing professional development and high-performance of QI team.
• Integrate all TennCare Medical Office programs (pharmacy, behavioral health, medical policy, provider services, and appeals) into the TennCare quality strategy and ensure evaluation and strong outcomes driven oversight
• Partner with other key TennCare divisions to integrate additional programs into Quality Strategy (e.g. LTSS, Value-Based payment programs)

Minimum Qualifications:

• 5+ years in clinical healthcare quality and reporting
• RN or higher clinical licensure preferred OR MPH/MHA or higher degree with focus on quality and health outcomes
• Experience in direct clinical operations, value-based system design, or certification in lean six-sigma processes. OR an equivalent combination of education and work experience may be considered.

Desirable qualifications:

• 3+ years working directly for a healthcare provider organization or health plan in quality can be substitute for educational requirements
• Prior experience leading and managing teams and direct reports
• Proficiency in Microsoft Office software including Word, Excel, and PowerPoint
• Excellent interpersonal, oral, and written communication skills
• Strong organizational, time management, analytical skills
• Experience in health care delivery and administration (hospital, physician practice, etc.) or state/federal health agency and policies
• Experience in managed care and/or quality improvement
• Experience with population health or value-based payment reforms

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.