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TennCare

Public Health Nursing Consultant 2

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

• Reviews, analyzes and interprets information from records to determine quality of care and compliance with state and federal rules and regulations. Conducts document reviews, observations, interviews to use the information to identify non-compliance with regulatory requirements. Applies federal & state rules and regulations in review and decision processes.
• Reviews medical records to determine medical eligibility or compliance.
• Leads assigned staff in using relevant information and individual judgment to determine whether events/decisions/processes comply with laws, regulations, and standards. Provides/communicates program specific information to staff/peers to achieve optimal outcome.
• Conducts employee orientations/training meetings as required to educate staff on departmental, state, and federal laws, rules, regulations, guidelines, benefits, processes, and procedures
• Organizes, analyzes and interprets applicant’s medical records to determine if medical eligibility has been met.
• Adheres to specific protocols provided by the state and federal agencies to accomplish all phases of assignments. Incorporates last minute and unscheduled tasks into current workload to ensure timely and accurate completion of work.
• Reviews and analyzes information to determine accurate decisions have been made. Determines the level of services applicants qualify for in accordance with rules and regulations.
• Demonstrates knowledge and skill in providing understandable responses to questions and is articulate in a wide range of difficult communication situations. Ensures confidential information/materials are not compromised. Serves as a resource person for the agency when communicating with health care facilities and entities.
• Identifies, develops, and maintains programmatic information needed to support program activities. Enters performance management related documents into appropriate data bases as required.
• Analyzes current processes and assists in development of innovative processes in order to improve program efficiency.
• Enters data/information into various computer programs using required documentation format.

Qualifications

The minimum qualifications are listed on the state of Tennessee’s Careers page link: https://www.tn.gov/careers/apply-here.html

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: March 10, 2021
  • Type: Full-Time
  • Job Function: Administrative
  • Service Area: Government