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:

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. TennCare's Medical Office is integral to this mission by leading clinical quality, operations, and strategic clinical innovation for the agency. The TennCare Pharmacy Unit (TPU) is an integral part of the TennCare Medical Office. This team is responsible for leading the pharmacy strategy and overseeing all operations of TennCare's pharmacy benefits which include the TennCare Medicaid, CoverKids, and CoverRx pharmacy programs. The TPU partners closely with its Pharmacy Benefits Administrator (PBA) to implement a comprehensive formulary, pricing, and rebate strategy for each of the pharmacy programs. It also supports the member and provider experience for prescribing, dispensing, and accessing needed medications. The TPU also ensures that TennCare's pharmacy programs are compliant with all federal and state requirements. It also serves as an important liaison between external pharmacy stakeholders and other agencies in support efficient delivery of pharmacy services for TennCare members. The Medical Office Programs Coordinator will work directly with other TennCare pharmacy leadership to improve overall care and outcomes for TennCare members utilizing prescription drug services, including improving members' access and medication adherence, and the coordination of medical and pharmacy benefits.

Key Responsibilities:

The Medical Office Programs Coordinator supports the management of the TennCare, CoverKids, CoverRx, and pharmacy programs. The Medical Office Programs Coordinator is responsible for effectively advancing operational efficiency and consistency of the pharmacy programs and staff. The Medical Office Programs Coordinator will provide project management support and process improvement to day-to-day pharmacy benefit operations.

1. Lead project management, strategic planning, and change management for priority TPU projects
2. Support TPU leadership in tracking progress and implementation of TennCare Medical Office and TPU strategic goals
3. Establish accountability processes for the achievement of all pharmacy targets, goals, and metrics
4. Utilize standardized process improvement strategies to advance team-based projects Partner with interdisciplinary teams and external partners to establish oversight and implementation of pharmacy projects and programs
5. Collaborate with business and Information Systems (IS) stakeholders, as well as other identified vendor partners, to gather detailed project requirements and match them to outlined project specifications and/or RFP requirements.
6. Create project charters and collaborative project plans for TennCare which include scope development, project goals, required deliverables and resources, budget planning, and a comprehensive project schedule
7. Track and communicate project metrics and benchmarks to be measured and reported upon. Support oversight of TennCare's PBA to ensure timely, efficient, and high-quality provision of pharmacy services to members
8. Develop and monitor key performance indicators of PBA functions including eligibility operations, reimbursement methodology, clinical formulary strategy, and contract compliance
9. Support pharmacy directors in developing processes and procedures to track PBA accountability in administering TennCare's pharmacy provider operations manual
10. Oversee and ensure PBA compliance with state and federal requirements Support TPU and Medical Office efforts to improve health outcomes for members
11. Research and maintain knowledge of national best practices related to Pharmacy services programs and pharmacy quality improvement
12. Develop, implement, and evaluate policies and procedures impacting member access to pharmacy benefits
13. Support a strong, collaborative team culture and participate in professional development

Minimum Qualifications:

1. A bachelor's degree in project management, business, public health or a related field and 3+ years full time professional experience in the relevant field. Equivalent combination of education and experience may be considered.
2. OR A bachelor's degree in public health, healthcare administration, or related field and 3+ years full time professional experience in a healthcare setting or coordinating the implementation of health programs
3. 3+ years of experience in project management or implementation of large-scale projects
4. PMP Certification or lean six-sigma process improvement certification
5. 2+ years full time experience in pharmacy program administration with pharmacy benefits managers or managed care organizations which may include:
6. Experience with prescription claims systems, rebate contracting and monitoring, utilization management setup
7. Steering on-going product evaluation, pharmacy performance trend monitoring, and adjusting and experience with medical and prescription benefits management
8. Master's degree in public health, healthcare administration, business administration, or certifications in lean six sigma or quality improvement
9. Experience in promoting disease state management, drug cost management or value-based prescription purchasing
10. Advanced computer skills including mastery of Microsoft Office (Excel, Access, Word, and PowerPoint, Excellent organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
11. Innovative thinking and problem-solving skills and ability to adapt to changing priorities
12. Strong work ethic, professionalism, and ability to work well with a team.
13. Clear, and concise presentation and written communication skills
14. Advanced time management 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.