TennCare Project Manager
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
TennCare is made up of the Tennessee Medicaid program, the Office of eHealth Initiatives, the Strategic Planning Initiatives Group and Cover Tennessee. TennCare’s Office of General Counsel (OGC) is responsible for providing legal advice and counsel to all divisions of TennCare. This Project Manager position is a newly formed position that will be in OGC’s Third Party Liability (TPL) unit. TPL refers to the legal obligation of third parties (for example, certain individuals, entities, insurers, or programs) to pay part or all the expenditures for assistance furnished under a State Medicaid or CHIP program. The obligations are referred to as Third Party Resources (TPRs). By law, all TPRs must meet their legal obligation to pay claims before the Medicaid or CHIP program pays. TennCare must take all reasonable measures to ascertain the legal liability of third parties to pay for care and services that are available to TennCare and CoverKids members.
- Oversee TPL reporting from TennCare partners (including Managed Care Organizations, Pharmacy and Dental Benefits Managers, and other contractors)
- Design report templates
- Compile and analyze reports
- Monitor compliance with reporting requirements
- Liaise with TennCare partners regarding reporting and other TPL matters
- Design database for centralized compilation of TPL information
- Oversee the design and implementation of data-driven process improvements
- Estimate the cost, savings, and impact of proposed TPL improvements
- Prepare reports for senior management detailing the risks and benefits of proposed improvements
- Participate in meetings with TennCare partners and internal staff regarding TPL
• Experience with relational databases and SQL
• Ability to communicate complex quantitative analysis in a clear, precise and actionable manner
• A strong passion for empirical research and for answering hard questions with data
• Ability to work independently and problem solve
• Strong analytical skills with ability to translate data analysis into business recommendations
• Ability to balance strong data analytics skills with a strategy-oriented mindset
• BA in relevant quantitative field (Mathematics/Statistics, Computer Science, Engineering)
For more information about the great benefits available to State of Tennessee employees; click here: https://www.tn.gov/hr/employees1/benefits.html
How to Apply
Please go to https://www.tn.gov/careers/apply-here.html. Search by “job title” or by “TennCare” to see all of our current job opportunities. Apply today!
- Date Posted: January 6, 2021
- Type: Full-Time
- Job Function: Executive Leadership
- Service Area: Government