LEGAL ASSISTANT - 79419

Executive Service

LEGAL ASSISTANT

Division of TennCare

Chief Medical Office (CMO)

Nashville, TN

Minimum Annual Salary $48,684.00

Closing Date: 08/17/2026

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 Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, TennCare operates under the oversight of the Centers for Medicare and Medicaid Services (CMS). Our mission is to provide high-quality, cost-effective care that improves the health and lives of our members.

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:

TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

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.

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system payment reform. TennCare's Medical Office is integral to this mission by leading clinical and quality oversight and strategic innovation for the agency. The medical office is responsible for all medical, dental, behavioral health and pharmacy policy, operations, and appeals as well as quality improvement and population health programming. When a TennCare Managed Care Contractor (MCC) makes an adverse benefit determination affecting one of their assigned TennCare enrollees, the enrollee has the right to appeal the determination to TennCare. Operationally, the TennCare Appeal Processing Unit works closely with several other TennCare divisions to help process TennCare member appeals for all eligible TennCare members to ensure they receive their medically necessary care. Externally, the Appeal Processing Unit (APU) works with TennCare's managed care organizations and other state agencies to ensure the provision of covered medical, dental, behavioral health, and pharmacy services for TennCare Members. This position will be a key member on the APU Valid Factual Dispute (VFD) team, reporting to the Valid Factual Dispute (VFD) Program Manager.

Key Responsibilities:

• The Legal Assistant will be responsible for researching and reviewing incoming TennCare medical, pharmacy, dental and behavioral health appeals and making complex decisions on both issues and appeals under the direction of the TennCare Managed Care Director. Determinations must be made timely and within a court-ordered deadline of 90 days for a standard appeal. Appeals of an adverse action that are reviewed are subject to a valid factual dispute determination unless untimely or enrollee is ineligible on the date of service.

• The Legal Assistant will also work with management to review member appeals and ensure appeals are processed in an accurate and timely manner- 40%

• The Legal Assistant duties will include researching the appeals tracking database, MATS, to determine if appeal information has been added; updating MATS as needed, drafting and editing documents related to each appeal case, sending and receiving appeal information to and from the managed care organizations, and organizing and maintaining documentation on case files processed by the Valid Factual Dispute Unit for easy retrieval- 30%

• The Legal Assistant will also write summations on appeal cases and edits summaries as needed, identifying and summarizing critical appeal issues for management review- 20%

• The Legal Assistant will perform other duties as assigned by the VFD Program Manager or APU Director- 10%

Minimum Qualifications:

Education and Experience:

Education equivalent to graduation from an accredited college, university, or professional school with one of the following:

(1) an Associate's Degree in Paralegal or Legal Assistant studies;

(2) a Bachelor's Degree in Paralegal or Legal Assistant studies;

(3) a Paralegal Certificate; or

(4) one year (28 semester hours) of graduate level law school. OR Education equivalent to graduation from a standard high school and two years of full-time experience in researching legal issues and documenting findings to assist in building case files, settling legal disputes, and/or providing legal counsel to clients.

Necessary Special Qualifications:

Positions within DHS may be required to: Complete a criminal history disclosure form in a manner approved by the appointing authority; Agree to release all records involving their criminal history to the appointing authority; Supply a fingerprint sample prescribed by the TBI based criminal history records clerk

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.