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TennCare

Regular Programs Manager

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 1.5 million Tennesseans and operates with an annual budget of approximately $12.9 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 a team of Managed Care Specialists who will utilize the TennCare Eligibility Determination System

(TEDS) to process renewals, applications, and case changes to determine eligibility for all TennCare programs

• Apply advanced knowledge of TennCare’ s business processes and policies to daily work operations

• Provide support and guidance to staff on matters relating to Medicaid rules, regulations, policies and procedures

• Conduct weekly team meetings to provide timely information regarding processes, initiatives, directives, and

training opportunities, as well as discuss staff ideas for continuous work process improvement

• Provide clear and concise verbal and written communication and guidance to staff in a positive manner

• Ensure all tasks are processed within the designated timeframe by monitoring, assessing, and addressing the

team’s overall performance

• Navigate, process, and troubleshoot renewals, applications, and case changes with TennCare’ s Tennessee

Eligibility Determination System (TEDS)

• Monitor staff production and quality by reviewing team performance reports and performing five case reads per

Managed Care Specialist

• Conduct regular coaching and guidance to ensure staff are meeting goals set forth by the agency and in

compliance with TennCare policy and following established business processes

• Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of

opportunity are resolved in a positive manner

• Utilize Edison to monitor leave balances, approve/deny leave requests and approving payable time

• Conduct monthly conferences timely and utilize the required written format

• Utilize the SMART formula to evaluate/rate employee performance throughout the performance review cycle

• 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

• Ensure that staff communicate with applicants, members, families, and Authorized Representatives to relay clear

information and expectations of the information needed for an accurate eligibility determination

• Work collaboratively and proactively with the TennCare Eligibility Director to identify areas of concern and create

continuous quality and process improvement plans

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: July 16, 2021
  • Type: Full-Time
  • Job Function: Administrative
  • Service Area: Government