MCC CHANGE PROGRAM MANAGER - 74587

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 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 1.4 million Tennesseans and operates with an annual budget of approximately $12 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

Key Responsibilities:

• Manage the work of APU MCO Change Legal Assistants including planning, assigning, scheduling, reviewing work product, and ensuring quality and performance standards are met.
• Assist in the development of APU MCO Change processes, templates, and training materials, utilizing available technologies to improve and promote efficiency, consistency, and compliance with TennCare business needs and with TennCare and federal regulatory requirements.
• Develop and communicate guidance and timelines to APU MCO Change Legal Assistants for deliverables associated with pending MCO Change appeals.
• Document key milestones and learnings gleaned throughout the lifecycle of pending MCO Change appeals and lead efforts to share best practices.
• Responsible for hiring, terminating, onboarding, training, developing, conducting formal performance reviews, and administering corrective actions for each MCO Change Legal Assistant. Additionally, responsible for performing logistical tasks in the absence of a direct report.
• Lead outreach efforts and feedback sessions including APU Staff, MCO staff, and other external groups to identify continued opportunities for improvement.
• Support the design, development and implementation of continued appeal tracking system process improvement.
• Handle special projects as assigned by the APU Deputy Director, APU Managing Attorney and/or the APU Director.
• Maintain extensive working knowledge of TennCare rules, operational procedures, and Centers for Medicare & Medicaid Services regulations and guidance.
• Collaborate closely with internal and external partners such as the Office of Fair Hearings staff and Long Term Services and Supports staff.
• Communicate clearly on complex appeals and decisions with direct reports, support staff, and TennCare leadership.
• Work independently on complex appeal matters and on major projects and initiatives.
• Develop and exhibit comprehensive understanding of the TennCare Rules and federal Medicaid regulations.

Minimum Qualifications:

• 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 Manager, 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 -

• Management experience is not required, but leadership potential and the demonstrated ability to supervise the work of other professionals is required;
• TennCare experience is preferred, particularly working with the TennCare Eligibility Determination System (TEDS), or the Medical Appeals Tracking System (MATS);
• Ability to work independently and to collaborate closely with team members in a hybrid environment (both in-person and virtually via Microsoft TEAMS);
• Demonstrated time management skills and proven ability to manage multiple tasks simultaneously while completing error-free work within allocated timeframes;
• The ability to adapt to changing priorities and deadlines, exercise sound judgment and possess strong organizational skills including the ability to prioritize, multi-task and manage a workload to meet specific timeframes and deadlines;
• Experience with MATS or other database applications
• Experience in the healthcare field

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.