Executive Service
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 $19 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 compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.
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.
The Division of TennCare, Tennessee Department of Finance and Administration, is currently seeking a qualified, experienced attorney to be a part of the Chief Medical Office Office of Fair Hearings (OFH). The Associate Attorney will provide legal representation and guidance in appeals of denied medical services submitted by TennCare enrollees, legal services attorneys, and private counsel. This role involves coordinating with Legal Assistants, managing case preparation, and maintaining accurate records to ensure efficient and effective legal proceedings. This role requires the ability to work both independently and collaboratively, often under tight deadlines. The position may involve occasional travel for hearings and case-related meetings. The OFH Associate Counsel bears responsibility for representing TennCare at the scheduled in-person or virtual hearing. The OFH Associate Counsel position will be responsible for working remotely except for occasional required in-office days.
Key Responsibilities:
Appeals Representation:
Represent the Division in appeals regarding denied medical services.
Engage with TennCare enrollees, legal services attorneys, private counsel, and other stakeholders involved in appeals.
Case Management:
Direct Legal Assistants in gathering necessary case information, including documents generated by the Division, Managed Care Contractors, enrollees, health providers, witnesses, and hearing exhibits.
Ensure completeness and accuracy of all case-related documentation.
Database Management:
Hearing Preparation:
Oversee the preparation of hearing exhibits, including collection, organization, and submission.
Inform witnesses of hearing procedures and coordinate their participation.
Review all drafts of case pleadings, including affidavits, motions, subpoenas, and other legal documents, to ensure accuracy and adherence to legal standards.
Team Collaboration:
Provide clear direction and guidance to Legal Assistants on case preparation and procedural requirements.
Collaborate with other team members to address complex legal issues and develop strategies for case resolution.
Minimum Qualifications:
Preferred Experience:
Desirable Qualifications:
Strong understanding of administrative law, healthcare law, and appeals processes.
Excellent organizational and case management skills.
Exceptional written and verbal communication abilities.
Ability to work collaboratively with a legal team and manage multiple priorities in a fast-paced environment.
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.
