Minimum Qualifications

SUMMARY: Under general supervision, is responsible for professional TennCare managerial and supervisory work of average difficulty; and performs related work as required.

DISTINGUISHING FEATURES: An employee in this class is responsible for managing a moderate sized TennCare section which is assigned complex duties. 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 most complex division or manages a large and/or most complex section.

Other Requirements

Manages staff in a TennCare administration program; observes employees as they perform assigned tasks to ensure efficiency in work activities; sets priorities on work to be done so more important tasks are given immediate attention; discusses methods to improve performance and motivate employees; informs employees of promotional and training opportunities; documents disciplinary actions taken against staff.
Assists in planning, organizing, and directing sectional operations and services; evaluates the organization, operations, and services of a program area; evaluates recommendations from staff to improve the economy, efficiency, and quality the section's operations and services.
Drafts new and revises existing contractual requirements with Managed Care Organizations (MCOs); monitors MCO compliance with contract requirements; makes recommendations for provider compliance with contracts.
Oversees the enforcement of policies and procedures for operations and services within the program area; develops and evaluates recommendations for changes in program policies and procedures; establishes specific work procedures that accomplish the goal of the policy.
Performs important public liaison work in explaining and interpreting the TennCare program; speaks to community groups, conferences, nursing homes, and advocacy groups to explain TennCare policies, procedures, rules, and regulations; conducts educational workshops for providers and enrollees to answer questions regarding the TennCare program.
Supervises staff who monitor fiscal agents involved in maintaining and updating the TennCare recipient database; evaluates methods and procedures used by the fiscal agents under contract; ensures computer programs are producing the desired outcomes (e.g., payments posted on time, MCOs notified of changes in enrollment, applications processed quickly); reviews reports to ensure compliance with systems contract.
Researches journal articles, statistical reports, and other sources to make recommendations about meeting the needs of the Long Term Care (LTC) population according to TennCare guidelines; develops and explains policies; functions as a liaison to LTC facilities regarding claims processing issues.

Job Overview

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.

Competencies (KSA's)

NECESSARY SPECIAL QUALIFICATIONS: None.

EXAMINATION METHOD: Education and experience rating, 100%.

State Employee Benefits

Insurance There are a variety of insurance options available to state employees including:

Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Annual Leave Full-time employees earn annual leave each month at a rated based on years of service as follows:

Years of Service

0 up to 5
5 up to 10
10 up to 20
20 or more

Annual Leave Earned per Month

1 day
1 and ½ days
1 and ¾ days
2 days

Maximum Allowable days

30 days
36 days
39 days
42 days
Leave earned in excess of the maximum allowable days will be transferred to the employee's sick leave account annually on the employee's anniversary hire date.

Sick Leave All full-time employees accrue 1 day (7.5 hours) of sick leave per month, provided they work the major portion of that month.
Bereavement Leave Leave with pay is granted for three days in the event of the death of an employee's spouse, child, stepchild, grandchild, parents, grandparents, siblings, stepparents, foster parents, or parents-in-law without charge to the employee's leave time. Two additional days of sick leave may be granted to provide a total of five days absence for this purpose.
Family Medical Leave Allows up to twelve work weeks of leave* each year to eligible employees for certain family and medical reasons. Continued health insurance coverage is provided during the leave period, and the employee is reinstated to the same or an equivalent position once the leave period has ended.
Leave may or may not be paid leave, depending on individual employee's leave balances for earned leave.

Parental Leave Parental leave is an absence from work granted any employee who has been employed in state service for at least 12 consecutive months as a full-time employee. Parental leave is a combination of sick, annual, or special leave without pay for a period not to exceed four months following the birth of a child.
Military Leave Granted in accordance with applicable state and federal laws, rules and regulations.
Holidays Each year, full-time state employees receive 11 holidays off with pay.
Retirement State employees are automatically members of the Tennessee Consolidated Retirement System . (TCRS) Employees must accrue 5 years of creditable state service to be vested (guaranteed retirement benefits when age requirements are met). Vested members of TCRS become eligible for service retirement upon completion of 30 years of creditable service or upon attainment of age 60.
Deferred Compensation Employees may choose to make pre-tax contributions to a variety of investment options through the 401(k) plan or the 457 plan. A minimum $20 monthly contribution is required to participate in the plans. For the 401(k) plan, the state will match the $50 per month minimum contribution. The $50 match policy is evaluated on an annual basis.
Flexible Benefits Plan Under this program certain specific expenses (e.g.,medical and dental insurance premiums, medical expenses, dependent day care expenses) can be deducted from an employee's paycheck prior to taxes, resulting in a lower taxable income level.
Higher Education Fee Discounts and Waivers A 25% discount on undergraduate tuition at any state operated institution of higher learning in Tennessee is available to children 23 years of age or under of full time state employees. In addition, full-time state employees with six months of continuous service are eligible to have tuition fees waived for one course per semester at a state institution. For further information on higher education discounts, click on Chapter 1540 on the Secretary of State Rules and Regulations web page.
Baccalaureate Education System Trust (BEST) Program (BEST) The Baccalaureate Education System Trust (BEST) was created by the Tennessee General Assembly for the purpose of providing Tennessee families with a means to save for their children's future college education costs.
Wellness Program The State Employee Wellness Program works to increase employees´ knowledge of options for healthier lifestyles through information and events that focus on improving behaviors affecting your health. Some specific benefits offered through the program include health risk assessments, fitness events, smoking cessation programs, and various other benefits.
Employee Assistance Program (EAP) EAP is a confidential counseling and referral service for all employees and their dependents. All services are strictly confidential and can be accessed 24 hours a day, 365 days a year.

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