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TennCare

Appeals Legal Review 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 AND DEPARTMENTAL OVERVIEW

The Division of TennCare seeks a Legal Review Attorney in the TennCare Eligibility Appeals Organization within the Division of Member Services. Under the general supervision of a Lead Attorney, a Legal Review Attorney will make a factual dispute determination on TennCare eligibility appeals. The Legal Review Attorney will be responsible for in-depth case research as it relates to TennCare Medicaid Policy. To obtain a just outcome, the Legal Review Attorney will work with Legal Assistants to gather additional information related to the appeal.

 

Job Responsibilities

• Research and review appeals in TennCare’s Tennessee Eligibility Determination System (TEDS) database and make a valid factual dispute determination

• Acquire and maintain a thorough understanding of Medicaid statutes, regulations and policies

• Review and monitor cases and appeals to ensure they are processed in compliance with Medicaid statutes, regulations and policies

• Identify issues affecting eligibility determinations and appeals and propose remedial measures

• Effectively communicate with and assist colleagues, management, and TennCare appellants as needed

Qualifications

MINIMUM 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

• Comfortable at adapt to changing priorities and deadlines

• Ability to exercise sound judgment

• Strong 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

 

DESIRABLE QUALIFICATIONS

 

• Experience with eligibility appeals procedures a plus

• Previous legal review experience a plus  

Additional Information

Benefits

To see all the great benefits available to State of Tennessee employees, go to the TN.gov Benefits page:  https://www.tn.gov/hr/employees1/benefits.html

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: February 17, 2021
  • Type: Full-Time
  • Job Function: Legal
  • Service Area: Government