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TennCare

Third Party Liability (TPL) Director

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

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 TPL Director position is a newly formed position that will be responsible for supervising and overseeing OGC’s Third Party Liability (TPL) unit. TPL refers to the legal obligation of third parties 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.

Job Responsibilities

  • Work with internal and external stakeholders to gain approval for and to implement improvements in TPL.
  • Assist in preparing and finalizing the RFPs related to contractor-provided TPL and Estate Recovery services.
  • Proactively participate in the RFP process by evlauating bids and helping to answer any questions posed.
  • Develop methods and metrics to monitor contract compliance of the TPL contractor.
  • Provide assistance to OGC’s Estate Recovery unit in developing methods and ensuring compliance of the Estate Recovery contractor.
  • Establish timeliness and customer service metrics and methods of quality review to ensure the RFR services meet customer expectations and will implement and monitor these methods for quality control and recordkeeping purposes.
  • Coordinate and conduct community education regarding TPL processes and its reliability to ensure consistent, active use. This includes but is not limited to conducting stakeholders and community focus groups aimed at generating feedback and providing education related to the RFR process. 
  • Provide regular updates to direct and indirect supervisors regarding the status of TPL projects.
  • Ensure that all TPL unit staff have sufficient training and resources to fulfill their performance expectations.
  • Provide direct, day-to-day supervision and training to the TPL Analyst and TPL Project Manager.
  • Develop and implement methods to monitor the work product and work quality of all TPL unit staff.
  • Conduct onboarding, offboarding, and performance management of all TPL unit staff. 

Qualifications

  • Applicants must hold a current, valid license to practice law in Tennessee or be eligible for licensure under Tennessee Supreme Court Rule 7, Article X.
  • Applicants must have demonstrable organization and communication skills
  • Applicants must have the ability to work independently and prioritize assignments.
  • Applicants must maintain excellent professional and interpersonal relationships and have the ability to take on multiple tasks on a wide variety of issues.
  • Applicants must be independently motivated to take initiative on large scale projects and be able to carry projects from start to finish

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: June 25, 2021
  • Type: Full-Time
  • Job Function: Administrative
  • Service Area: Community Development