Quality Control Specialist

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

This position will work in the Compliance and Policy Group of Member Services and will report directly to the Assistant Quality Control Director.  This position is responsible for performing accurate quality control functions within the Tennessee Eligibility Determination System (TEDS), implementing federally mandated audit activities, and undertaking proactive reviews of Member Services operations.   This position requires the ability to provide accurate and concise responses to quality control inquires relating to all aspects of Medicaid eligibility and Member Services operations.

RESPONSIBILITIES

• Review and analyze caseworkers’ actions taken in TEDS to determine accuracy and compliance.
• Review and analyze business processes, system functionality, and eligibility documentation to ensure compliance with regulatory authority and internal requirements.
• Remain current on all Medicaid eligibility policy updates and TEDS design materials.
• Implement corrective action plans resulting from audit/quality control findings.
• Field and respond to all eligibility-related questions from internal and external stakeholders.

Qualifications

MINIMUM QUALIFICATIONS

• Bachelor’s Degree
• Ability to foster and maintain cohesive working relationships
• Ability to 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 required
• Strong grasp of Medicaid policy

DESIRABLE QUALIFICATIONS

• Experience in quality control such as evaluating the quality of services, identifying problems and needs, and recommending corrective action and improvements to ensure optimum service delivery will be considered a plus.

Additional Information

Benefits

How to Apply

Please go to https://www.tn.gov/careers/apply-here.html to apply for this job today.

Details

• Date Posted: March 17, 2020
• Type: Full-Time
• Job Function: Analytics / Evaluation
• Service Area: Government