Appeals Legal Review Lead Attorney

TennCare

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Job Summary

TENNCARE 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).

WHY WORK AT TENNCARE

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 work 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 Responsibilities

• Supervise five Legal Review Attorneys.
• 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, time management, and handle the performance process including goal evaluation and document initial, interim, and annual reviews.
• 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.
• Manage weekly team meetings when required.

Qualifications

• Bachelor’s Degree from an accredited college or university
• Juris Doctor from an accredited college or university
• Active License to practice law in Tennessee
• Ability to foster and maintain cohesive working relationships
• Ability to adapt to changing priorities and deadlines
• 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
• Ability to interpret and execute public policy
• Developed leadership capabilities
• Expert knowledge of legal review processes, criteria, and recommendations
• Advanced knowledge of EOG and AOG functional teams, processes and, requirements

Additional Information

Benefits

How to Apply

To apply for this job or see other opportunities at TennCare, visit the state of Tennessee’s Careers page today: https://www.tn.gov/careers/apply-here.html

Details

• Date Posted: May 7, 2021
• Type: Full-Time
• Job Function: Administrative
• Service Area: Government