PROVIDER ENGAGEMENT MANAGER - 71950

Executive Service

PROVIDER ENGAGEMENT MANAGER

Division of TennCare

Chief Medical Office (CMO)

Nashville, TN

Salary : Minimum Monthly Salary $5,100 / 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 / 20 / 2025

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 Provider Services Division (PS) is an integral team within the TennCare Chief Medical Office (CMO) responsible for supporting the provider enrollment process, supporting the TennCare provider experience, and overseeing strong provider networks for TennCare members. Operationally, the Provider Services Division works closely with existing healthcare providers as well as healthcare providers seeking to newly enroll with TennCare. The PS Division is responsible for screening, enrollment, credentialing, monitoring, reporting, and activities designed to streamline provider participation processes. Additionally, the PS Division works closely with the TennCare Managed Care Contractors (MCCs) ensuring MCCs have accurate information to contract with providers and that each MCC maintains robust provider networks to ensure access to care for TennCare members. The PS Division is committed to engaging TennCare providers to help optimize their experiences serving TennCare members.

The Provider Engagement (PE) Manager will be a key leader on the Provider Services management team collaborating with the Director of Provider Experience and leadership across the Chief Medical Office to oversee strategic plans by both TennCare and the MCCs to engage medical, behavioral, dental and pharmacy providers. The Provider Engagement Manager will oversee the annual provider engagement strategy across the medical office and streamlines current processes and enhance provider experience while reducing provider abrasion. The PE Manager will coordinate all efforts within the provider engagement division to include planning, directing, organizing, and evaluating the implementation of strategic plans that will ensure provider interactions with TennCare are positive and effective. The PE Manager works closely with MCCs to establish strong relationships to advance their partnership in service to TennCare members; and will works closely with external and internal stakeholders to oversee provider enrollment, education, and network monitoring activities.

Key Responsibilities :

• Directly lead and have primary accountability for the TennCare provider engagement
• Develop, implement, and coordinate a comprehensive provider engagement strategy across the TennCare that supports proactive communication and outreach to TennCare providers
• Develop and maintain positive, long-term relationships with physicians, healthcare providers and healthcare systems to support and improve relationships with TennCare and its MCCs
• Coordinate with key TennCare teams and MCCs to ensure efficient and high-quality transfer of necessary provider information and education materials
• Identify new best practices and opportunities for continued advancement and evolution of a provider-friendly experience with TennCare
• Provide exceptional customer service and collaborate effectively with internal and external stakeholders to problem-solve provider issues and develop systemic solutions
• Lead cross-functional efforts with TennCare and its MCCs to resolve high-priority individual medical care issues for providers and / or members to ensure appropriate care is delivered
• Analyze provider engagement strength and opportunities. Identify systemic solutions to proactively address operational challenges that may be leading to inefficient provider processes or negatively impacting provider processes
• Represent TennCare at state-wide provider association conferences and other public forums to provide education and support on TennCare resources
• Lead project management and develop reporting mechanisms to track successes, and opportunities for improvement related to provider experience
• Support the enhancement of member access and provider experience by reducing ghost provider networks by improved oversight of MCC network adequacy and validation.
• Develop and implement strategy to target engagement plans for inactive providers to encourage increased participation and utilization within the network.
• Establish clear communication channels to regularly update MCCs and DBM on network requirements and performance metrics.
• Support the Provider Services Division and other Medical Office initiatives to strengthen relationships and improve TennCare Provider experience
• Foster professional working relationships with TennCare Chief Medical Office Divisions by participating in planning provider engagement related activities for each CMO Division
• Identify and research national best practices to leverage across the TennCare program

Minimum Qualifications :

Education and Experience : Graduation from an accredited college or university with a bachelor's degree and experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization, of which two years must include drafting contractual requirements, developing rules and regulations, or supervising professional staff who deal with health insurance.

Substitution of Experience for Education : Five years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, and / or Managed Care Division Director with the State of Tennessee, of which one year must be at the Managed Care Specialist 3 or higher level.

Desirable Qualifications

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.