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 Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, TennCare operates under the oversight of 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 is seeking a TennCare Eligibility Director in the Appeals Operation Group within Member Services. The Appeals Litigation Preparation Director will provide operational oversight and leadership to the Appeals Operations Group. They will work under the immediate supervision of the TennCare Litigation Appeals Administrator. This position will be indirectly supervising Legal Assistants as well as TennCare Program Coordinators and directly supervising TennCare Program Manager 2s. The Appeals Litigation Preparation Unit prepares appeals for administrative hearing, reviews, and processes eligibility when appropriate, and testifies on behalf of the Division of TennCare at hearing. The Appeals Litigation Preparation Director will develop unit goals, priorities, objectives, and strategies. Additionally, the Director will ensure communication and action plans are developed efficiently and effectively implemented within their area of responsibility. The Director will collaborate with the Appeals Litigation Director to develop and implement quality assurance measures; ensure problem solving and decision-making processes are utilized to maximize the efficiency of the appeals litigation process; and monitor the risk and quality of all aspects of the appeals litigation process. Lastly, the Appeals Litigation Preparation Director must maintain a current knowledge base of policy and regulations surrounding Medicaid.
Key Responsibilities:
Supervise four Program Manager 2s and indirectly supervise twenty-eight Appeal Coordinators, Legal Assistants, and other worker level staff
Acquire and maintain a thorough understanding of Medicaid statutes, regulations, and policies
Identify issues affecting eligibility determinations and appeals and propose remedial measures.
Develop team goals, priorities, objectives, and strategies for staff.
Ensure all appeals are processed within the designed time frame given by monitoring, assessing, and addressing the team's overall performance.
Oversee the ongoing team specific training efforts and manage the performance process including goal evaluation and document initial, interim, and annual reviews.
Effectively communicate with, and aid, colleagues and TennCare members and applicants as needed.
Provide on-going coaching and guidance to ensure staff are processing Appeals in compliance with TennCare policy, Medicaid statutes, regulations, and policies.
Build team morale to ensure staff have a positive and inclusive work environment, which leads to higher job satisfaction, and results in greater team efficiencies and effectiveness.
Minimum Qualifications:
Education and Experience: Graduation from an accredited college or university with a bachelor's degree in a related field and two (2) years of qualifying professional experience; OR graduation from an accredited college or university with an associate degree in the related field and four (4) years of qualifying professional experience; OR eight (8) or more years of qualifying professional experience An equivalent combination of education and work experience may be considered
Desirable Qualifications:
Professional experience with health insurance, managed care, health care claims, Medicaid rules and regulations
A master's degree in one of the following: public health, business administration or public policy
Ability to foster and maintain cohesive working relationships -Ability to adapt to changing priorities and deadlines
Ability to be flexible and accountable
Ability to coach and mentor a diverse workforce
Demonstrate passion and commitment
Ability to exercise sound judgment
Excellent organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
Excellent writing and communication skills required
Ability to interpret and execute public policy
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.
