1 VENDOR OPERATIONS REPORTING & QC MANAGER - 60902 Job in Davidson, TN
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VENDOR OPERATIONS REPORTING & QC MANAGER - 60902
$115k-144k (estimate)
Full Time | Public Administration
1 Week Ago
State of Tennessee is Hiring a VENDOR OPERATIONS REPORTING & QC MANAGER - 60902 Near Davidson, TN
Work Activities
Executive ServiceVENDOR OPERATIONS REPORTING & QC MANAGERDivision of TennCareMember Services - Vendor Operations Group (VOG)Nashville, TNSalary: Minimum Monthly Salary $5,050/month Closing Date: 09/09/2024TennCare 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.
Who We Are And What We DoTennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
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 OverviewThe Vendor Operations Group within the Division of TennCare is seeking a Managed Care Program Manager 2 to work in the TennCare Vendor Operations Group. The Managed Care Program Manager 2 will report directly to an Executive Administrative Assistant 2 (EAA2). This position will manage a team of TennCare Program Coordinators and/or other positions possibly to include Temporary Resources who will utilize the TennCare Eligibility Determination System (TEDS) to assist in processing applications and verifications for determining Medicaid eligibility as well as the PERLSS system in providing guidance and support for CHOICES and other waiver programs through LTSS Help Desk. They will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations, and policies. The Managed Care Program Manager2's responsibilities and duties are subject to change per the need of the Division of TennCare.
Key Responsibilities
Substitution of Experience for Education: Five 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.
An equivalent combination of education and work experience may be considered.
Executive ServiceVENDOR OPERATIONS REPORTING & QC MANAGERDivision of TennCareMember Services - Vendor Operations Group (VOG)Nashville, TNSalary: Minimum Monthly Salary $5,050/month Closing Date: 09/09/2024TennCare 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.
Who We Are And What We DoTennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
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 OverviewThe Vendor Operations Group within the Division of TennCare is seeking a Managed Care Program Manager 2 to work in the TennCare Vendor Operations Group. The Managed Care Program Manager 2 will report directly to an Executive Administrative Assistant 2 (EAA2). This position will manage a team of TennCare Program Coordinators and/or other positions possibly to include Temporary Resources who will utilize the TennCare Eligibility Determination System (TEDS) to assist in processing applications and verifications for determining Medicaid eligibility as well as the PERLSS system in providing guidance and support for CHOICES and other waiver programs through LTSS Help Desk. They will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations, and policies. The Managed Care Program Manager2's responsibilities and duties are subject to change per the need of the Division of TennCare.
Key Responsibilities
- Supervise a team of TennCare Program Coordinators and/or other levels of staff.
- Provide support and guidance to staff relating to Medicaid rules, regulations, policies, and procedures.
- Conduct weekly team meetings and monthly staff conferences 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.
- Assist in guidance of LTSS Help Desk agents as they handle incoming calls to provide effective and efficient customer service and appropriately document all calls and inquiries.
- Assist in research inquiries or questions and conduct outbound calls as needed to provide correct or additional information to help resolve inquiries and provide excellent customer service.
- Ensure all tasks are processed within the designated timeframe by monitoring, assessing, and addressing the team's overall performance.
- Monitor staff production and quality by reviewing team performance reports.
- Manage staff as they conduct audits of phone calls, tasks, chats, and documents in support of Contract service level agreements as well as LTSS Help Desk.
- 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 approve payable time.
- 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.
- Analyze audit data to establish trends and determine root causes.
- Prepare reports to document trends and propose corrective actions.
- Resolve member's issues by taking the appropriate action when applicable.
- Maintain knowledge of changing policies and processes within the organization.
- Participate in other special projects as business needs dictate.
Substitution of Experience for Education: Five 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.
An equivalent combination of education and work experience may be considered.
- Ability to foster and maintain cohesive working relationships.
- Ability to adapt to changing priorities and deadlines.
- Ability to learn quickly and exercise sound judgment.
- Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines.
- Advanced writing and communication skills.
- 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.
- Ability to coach and mentor a diverse workforce.
- Ability to interpret and execute policies and procedures.
- Ability to take initiative with tasks.
- Ability to be flexible and accountable.
- Demonstrate passion and commitment.
- Advanced research skills, including the ability to locate and analyze documents and integrate information from multiple sources.
- Strong work ethic with an ability to receive and implement constructive feedback.
- Advanced customer service skills, including the ability to problem solve, handle difficult situations, and escalate issues when necessary.
- Ability to read and speak Spanish fluently.
- Minimum of one year experience working in eligibility determination.
- Minimum of one year experience working with complex Waiver programs including ECF Choices, Katie Beckett, etc.
- Advanced experience working with Excel.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Public Administration
SALARY
$115k-144k (estimate)
POST DATE
09/06/2024
EXPIRATION DATE
10/03/2024
WEBSITE
tn.gov
HEADQUARTERS
NASHVILLE, TN
SIZE
15,000 - 50,000
FOUNDED
1976
TYPE
Private
CEO
BILL LEE
REVENUE
$10B - $50B
INDUSTRY
Public Administration
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