Job Information
State of Tennessee Job Information
Opening Date/Time10/27/2026 12:00AM Central TimeClosing Date/Time11/09/2026 11:59PM Central TimeSalary (Monthly)$4,608.00Salary (Annually)$55,296.00Job TypeFull-TimeCity, State LocationNashville, TNDepartmentTennCare
LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, DAVIDSON COUNTY
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.
Qualifications
Education and Experience: Graduation from an accredited college or university with a bachelor's degree and 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, of which one year must include drafting contractual requirements, developing rules and regulations, or supervising professional staff who deal with health insurance.
Substitution of Experience for Education: Qualifying professional experience interpreting policy or procedural provisions for a related health insurance organization may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).
OR
Four years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, 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.
Overview
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.
Under general supervision, is responsible for managing a moderate sized section providing oversight of TennCare's managed care entities to ensure contract compliance, program integrity, and operational efficiency. This class differs from that of Managed Care Specialist 3 in that an incumbent of the latter functions at a highly technical professional level or supervises a small to moderate sized section which is assigned duties of routine to average complexity. This class differs from that of Managed Care Program Mgr 2 in that an incumbent of the latter is responsible for assisting in directing the activities and services of a complex division or manages a large complex section.
Responsibilities
- Supervise a team of Managed Care Specialists who will utilize the TennCare Eligibility Determination System (TEDS) to process renewals, applications, and case changes to determine eligibility for all TennCare programs based on Financial and Non-Financial criteria.
- Apply advanced knowledge of TennCare' s business processes and policies to daily work operations
- Provide support and guidance to staff on matters relating to Medicaid rules, regulations, policies and procedures
- Conduct weekly team meetings to provide timely information regarding processes, initiatives, directives, and training opportunities, as well as discuss staff ideas for continuous work process improvement
- Provide clear and concise verbal and written communication and guidance to staff in a positive manner
- Ensure all tasks are processed within the designated timeframe by monitoring, assessing, and addressing the team's overall performance
- Navigate, process, and troubleshoot renewals, applications, and case changes with TennCare' s Tennessee Eligibility Determination System (TEDS)
- Remain up to date on new policies and procedures as they are implemented to ensure accurate eligibility determinations
- Monitor staff production and quality by reviewing team performance reports and performing five case reads per Managed Care Specialist
- Conduct regular coaching and guidance to ensure staff meet goals set forth by the agency and in compliance with TennCare policy and following established business processes
- Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of opportunity are resolved in a positive manner
- Utilize Edison to monitor leave balances, approve/deny leave requests and approving payable time
- Conduct monthly conferences timely and utilize the required written format
- Utilize the SMART formula to evaluate/rate employee performance throughout the performance review cycle
- 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
- Ensure that staff communicate with applicants, members, families, and Authorized Representatives to relay clear information and expectations of the information needed for an accurate eligibility determination.
- Work collaboratively and proactively with the TennCare Eligibility Director to identify areas of concern and create continuous quality and process improvement plans
- Lead the end-to-end onboarding experience, ensuring new team members have the clarity, resources, and support needed for a successful transition.
Competencies (KSA's)
Competencies:
- Optimizes Work Processes
- Directs Work
- Courage
- Organizational Savvy
- Builds Effective Teams
Knowledge:
- Administration Management
Skills:
- Active Learning and Listening
- Critical Thinking
- Speaking
- Management of Personnel Resources
- Complex Problem Solving
Abilities:
- Deductive Reasoning
- Selective Attention
- Written Comprehension
- Speech Clarity
Tools & Equipment
- Personal Computer
- Telephone
- Fax Machine
- Printer
- Copier/Scanner