APPEALS ORDER IMPLEMENTATION DIRECTOR - 70835

Executive Service

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

Background Check:

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

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 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS). 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 worked 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 Overview:

The Division of TennCare is seeking a TennCare Eligibility Director in the Appeals Operation Group within Member Services. The Appeals Order Implementation Director will provide operational over-site and leadership to the Appeals Operations Group. They will work under the immediate supervision of the TennCare Appeals Litigation Administrator. This position will be indirectly supervising Legal Assistants and directly supervising TennCare Program Manager 2s. The Appeals Order Implementation Director ensures all Orders are implemented in accordance with legal authority, applicable TennCare policy, and internal timelines. The Appeals Order Implementation Director will develop unit goals, priorities, objectives, and strategies for the Order Implementation Unit. Additionally, the Director will ensure communication and action plans are developed efficiently and effectively implemented within their area of responsibility. The Director will develop and implement quality assurance measures; ensure problem solving processes are utilized to maximize the efficiency of the appeals implementation process; and monitor the risk and quality of all aspects of the implementation process. The Appeals Order Implementation Director must maintain a current knowledge base of policy and regulations surrounding Medicaid.

Key Responsibilities:

• Supervise two Program Manager 2s and indirectly supervise fourteen Legal Assistants.
• Acquire and maintain a thorough understanding of Medicaid statutes, regulations, and policies
• Identify issues affecting eligibility determinations and appeals and propose remedial measures.
• Develop team goals, priorities, objectives, and strategies for staff.
• Ensure all appeals are implemented within the designed time frame given by monitoring, assessing, and addressing the team's overall performance.
• Oversee the ongoing team specific training efforts and manage the performance process including goal evaluation and document initial, interim, and annual reviews.
• Effectively communicate with, and aid, colleagues and TennCare members and applicants as needed.
• Provide on-going coaching and guidance to ensure staff are processing Appeals in compliance with TennCare policy, Medicaid statutes, regulations, and policies.
• 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.

Minimum Qualifications:

Preferred Education & Experience:

Graduation from an accredited college or university with a bachelor's degree in a related field and two (2) years of qualifying professional experience;

OR

Graduation from an accredited college or university with an associate degree in the a related field and four (4) years of qualifying professional experience;

OR

Eight (8) or more years of qualifying professional experience.

OR

an equivalent combination of education and work experience may be considered.

Desirable Qualifications:

Professional experience with health insurance, managed care, health care claims, Medicaid rules and regulations

A master's degree in one of the following: public health, business administration or public policy

• Ability to foster and maintain cohesive working relationships
• Ability to adapt to changing priorities and deadlines
• Ability to be flexible and accountable
• Ability to coach and mentor a diverse workforce
• Demonstrate passion and commitment
• Ability to exercise sound judgment
• Excellent 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
• Ability to interpret and execute policy

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.