State of Tennessee · 8 hours ago
MCC CHANGE PROGRAM MANAGER - 74587
Davidson County, TN
Full-time
Hybrid
Senior Level
5+ years expThe State of Tennessee's Division of TennCare is seeking a MCC Change Program Manager to oversee the APU MCO Change Legal Assistants and improve operational processes. The role involves managing staff, developing training materials, and ensuring compliance with regulatory requirements.
AgricultureChildrenEducationGovernmentHealth Care
Responsibilities
Manage the work of APU MCO Change Legal Assistants including planning, assigning, scheduling, reviewing work product, and ensuring quality and performance standards are met
Assist in the development of APU MCO Change processes, templates, and training materials, utilizing available technologies to improve and promote efficiency, consistency, and compliance with TennCare business needs and with TennCare and federal regulatory requirements
Develop and communicate guidance and timelines to APU MCO Change Legal Assistants for deliverables associated with pending MCO Change appeals
Document key milestones and learnings gleaned throughout the lifecycle of pending MCO Change appeals and lead efforts to share best practices
Responsible for hiring, terminating, onboarding, training, developing, conducting formal performance reviews, and administering corrective actions for each MCO Change Legal Assistant. Additionally, responsible for performing logistical tasks in the absence of a direct report
Lead outreach efforts and feedback sessions including APU Staff, MCO staff, and other external groups to identify continued opportunities for improvement
Support the design, development and implementation of continued appeal tracking system process improvement
Handle special projects as assigned by the APU Deputy Director, APU Managing Attorney and/or the APU Director
Maintain extensive working knowledge of TennCare rules, operational procedures, and Centers for Medicare & Medicaid Services regulations and guidance
Collaborate closely with internal and external partners such as the Office of Fair Hearings staff and Long Term Services and Supports staff
Communicate clearly on complex appeals and decisions with direct reports, support staff, and TennCare leadership
Work independently on complex appeal matters and on major projects and initiatives
Develop and exhibit comprehensive understanding of the TennCare Rules and federal Medicaid regulations
Qualification
Required
Graduation from an accredited college or university with a bachelor's degree
Experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization
Two years of experience must include drafting contractual requirements, developing rules and regulations, or supervising professional staff who deal with health insurance
Five years of full-time work as a Managed Care Specialist, Managed Care Program Manager, and/or Managed Care Division Director with the State of Tennessee, of which one year must be at the Managed Care Specialist 3 or higher level
Preferred
Management experience is not required, but leadership potential and the demonstrated ability to supervise the work of other professionals is required
TennCare experience is preferred, particularly working with the TennCare Eligibility Determination System (TEDS), or the Medical Appeals Tracking System (MATS)
Ability to work independently and to collaborate closely with team members in a hybrid environment (both in-person and virtually via Microsoft TEAMS)
Demonstrated time management skills and proven ability to manage multiple tasks simultaneously while completing error-free work within allocated timeframes
The ability to adapt to changing priorities and deadlines, exercise sound judgment and possess strong organizational skills including the ability to prioritize, multi-task and manage a workload to meet specific timeframes and deadlines
Experience with MATS or other database applications
Experience in the healthcare field
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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