State of Tennessee · 13 hours ago
QUALITY & COMPLIANCE DIRECTOR - 74266
Davidson County, TN
Full-time
Hybrid
Lead/Staff, Director/Executive
2+ years expThe State of Tennessee is seeking a Quality and Compliance Director for the Division of TennCare, which provides health insurance coverage to low-income individuals. The role involves overseeing compliance and quality control audits, facilitating various audits, and collaborating with internal and external stakeholders to ensure adherence to eligibility and quality standards.
AgricultureChildrenEducationGovernmentHealth Care
Responsibilities
Provide high-quality customer service to the Centers for Medicare & Medicaid Services, the Comptroller of the Treasury, and other external audit-related stakeholders
Oversee audit work related to the PERM audit, MEQC audit, Comptroller Audit, and annual Risk Assessment, among others
Effectuate change across Member Services via case corrections and corrective action plans (CAPs)
Provide oversight and guidance to three groups of staff: Audit/Quality Control, Compliance, and Eligibility Fraud
Maintain a strong understanding of eligibility policies and procedures and apply this knowledge to eligibility audits and quality control tasks
Oversee the PARIS inquiry process, ensuring timely and accurate communication with external stakeholders
Provide guidance related to the Inmate Suspension process, ensuring timely and accurate resolution of Inmate Suspension tasks
Oversee eligibility fraud investigative work, ensuring timely and accurate communication with external stakeholders
Ensure and oversee participation the Audit teams' involvement in the Case Reads process to ensure Case Reads outcomes align with federal and state audit expectations
Ensure TennCare is compliant with federal reporting requirements
Perform vendor compliance tasks, as needed
Qualification
Required
Graduation from an accredited college or university with a bachelor's degree in a related field and two (2) years of qualifying professional experience
Graduation from an accredited college or university with an associate degree in a related field and four (4) years of qualifying professional experience
eight (8) or more years of qualifying professional experience
an equivalent combination of education and work experience may be considered
Strong customer service skills, including the ability to problem solve, handle difficult situations, and escalate issues when necessary
Excellent communication skills, both oral and written
Advanced research skills, including the ability to locate and analyze documents and integrate information from multiple sources, including researching computer systems
Excellent organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines
Ability to foster and maintain cohesive working relationships
Ability to interpret and execute policies and procedures
Ability to exercise sound judgment
Strong work ethic, with an ability to receive and implement constructive feedback
Ability to work independently while also working as part of a team in a fast-paced environment
Willingness to support and foster the team's culture
Company
State of Tennessee
State government is the largest employer in Tennessee, with approximately 43,500 employees in the three branches of government.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Hugh Hale
Chief Information Officer, TennCare
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