Managed Care Specialist 3

Job Information

State of Tennessee Job Information Opening Date/Time 04/29/:00AM Central Time Closing Date/Time 05/12/:59PM Central Time Salary (Monthly) $3,595.00 - $5,380.00 Salary (Annually) $43,140.00 - $64,560.00 Job Type Full-Time City, State Location Nashville, TN Department TennCare
LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, TENNCARE DIVISION, DAVIDSON COUNTY

Minimum Monthly Salary $3,595/month 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.

This position requires a 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 or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.
Substitution of Experience for Education: Qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting 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). Substitution of Experience for Education: Two years of full-time work as a Managed Care Specialist with the State of Tennessee. Necessary Special Qualifications: A valid motor vehicle operator's license may be required. Examination Method: Education and Experience,100%, for Preferred Service positions. For Executive Service positions, Minimum Qualifications, Necessary Special Qualifications, and Examination Method are determined by the appointing authority. Overview

Summary: Under general supervision, is responsible for highly technical professional TennCare program work of considerable difficulty and/or supervisory work of average difficulty; and performs related work as required. Distinguishing Features: This is the highly technical professional or supervisory class in the Managed Care Specialist sub-series. An employee in this class performs highly technical TennCare program work or supervises a small to moderate sized unit of Managed Care Specialists and/or sub professional staff performing TennCare duties. This class differs from Managed Care Specialist 2 in that an incumbent of the latter performs TennCare program work of average difficulty and is not responsible for highly technical or supervisory work. Responsibilities

Monitoring and Controlling Resources:
•  Identifies inconsistencies and errors in policies, rules, procedures and suggest corrective action to management.
•  Follows policies, rules, procedures to ensure that taxpayers receive value from tax dollars.
•  Ensures resources are available to allow staff to complete job duties in a timely and efficient manner. Establishing and Maintaining Interpersonal Relationships:

•  Networks with external and internal business partners to ensure open dialogue exists and to facilitate coordination and unified effort.
•  Maintains professional working relationships with peers and with upper management to ensure smooth and effective team operations.
•  Leads peers/subordinates to liaise with other state agencies, and outside entities to ensure accurate and timely processing of enrollee/provider requests. Processing Information:

•  Leads peers/subordinates in compiling information received via mail/fax/call center into an electronic database to begin initial process for program participation related to application, appeals, recertification's, etc.
•  Leads peers/subordinates in preparing provider rates for nursing homes and out of state hospitals to be loaded into electronic database to determine the appropriate per diem rate paid for services rendered.
•  Processes returned information to verify specific enrollment or denial criteria for participation in the HCFA/TennCare program.
•  Processes information sent to and received from contractors to determine the next step in the appeals process and assigns the process to a peer/subordinate.
•  Verifies provider information received to initiate a survey from Department of Health, Healthcare Facilities, for the purpose of opening a new Intermediate Care Facility for the developmentally challenged.
•  Calculates information received from contractors and compiles data for monthly and quarterly federal reporting.
•  Verifies the accuracy and completeness of information received, and ensures that it is processed within required time frames. Communicating with Supervisors, Peers, or Subordinates:

•  Provides regular updates to upper management and other internal business partners on the status of assigned work or an assigned project to facilitate understanding and resolution.
•  Conducts a variety of meetings to provide and gather status updates for assigned workload.
•  Provides updates to assigned supervisor to ensure accurate and timely receipt of instructions and work assignments. Communicating with Persons Outside Organization:

•  Communicates with external business partners with appropriate written or oral notifications related to specific program information to ensure understanding, facilitate services and expedite claims or appeals.
•  Contacts vendors and other outside agencies related to HCFA/TennCare to obtain/provide required information and/or for clarification purposes.
•  Answers or responds to complex inquiries from external business partners for the purpose of relaying and/or correcting information, and policy/guideline interpretation. Staffing Organizational Units:

•  Anticipates staffing needs and requests hiring requisition within stated guidelines to ensure appropriate staffing levels for work at hand.
•  Interviews selected applicants using applicable state and federal guidelines to choose the most suited candidate for the open position.
•  Uses best business practices to appoint and promote most qualified employee for assigned position. Provide Consultation and Advice to Others:

•  Provides consultation and advice relating to federal and state health policies to internal and external partners, applicants and other interested stakeholders.
•  Trains/educates internal and external partners and other interested stakeholders related to agency programs and services. Guiding, Directing, and Motivating Subordinates:

•  Completes the performance management process for each direct report to include a job planning discussion, two interims and a formal evaluation, all based on the SMART formula.
•  Provides ongoing feedback related to assigned tasks to ensure complete understanding, accuracy of work and appropriate deadlines are met. Making Decisions and Solving Problems:

•  Leads the analysis of data received from contractors to ensure accuracy and functional performance prior to live implementation.
•  Analyzes errors identified through electronic process and assigns to peers/subordinates to resolve issues in order to complete enrollment in the HCFA/TennCare program. Updating and Using Relevant Knowledge:

•  Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field in order to access applicable systems.
•  Utilizes acquired knowledge and skills to improve daily performance of assigned tasks. Identifying Objects, Actions, and Events:

•  Leads the identifying of those appeals indicated as emergency appeals to ensure they are processed timely and within the required time frame.
•  Leads the identifying of those appeals indicated as standard appeals to ensure they are processed within the required time frame. Judging the Qualities of Things, Services, or People:

•  Leads in assessing the information received through the Help Desk/Call Center to evaluate and/or prioritize for issue resolution. Analyzing Data or Information:

•  Leads the analysis of data received from contractors to ensure accuracy and functional performance prior to live implementation. Interacting With Computers:

•  Uses appropriate data base tracking software, specific to the State and Agency, as required, to perform assigned tasks.
•  Uses office productivity software, including but not limited to, word processing programs, spreadsheets programs, presentation software . click apply for full job details