MANAGED CARE PROGRAM MANAGER 1

State of Tennessee
US - Tennessee - Nashville
January 10, 2025

Job Information

State of Tennessee Job Information

Opening Date/Time 01/07/2025 12:
00AM Central Time Closing Date/Time 01/13/2025 11:
59PM Central Time Salary (Monthly) $4,517. 00 - $6,768. 00 Salary (Annually) $54,204. 00 - $81,216. 00 Job Type Full-Time City, State Location Nashville, TN Department TennCare

LOCATION OF (1) POSITION TO BE FILLED:
DEPARTMENT OF TENNCARE, DIVISION OF TENNCARE, ELIGIBILITY DETERMINATION STAFF, DAVIDSON COUNTY

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 compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy. 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 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. Necessary Special Qualifications:
None. 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 professional 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 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.

Responsibilities

Interacting With Computers:

Uses appropriate database tracking software specific to the state and agency, as required.
Uses office productivity software including but not limited to word processing programs, spreadsheet programs, presentation software, web-based email programs, instant messaging programs, and search engines.

Developing Objectives and Strategies:

Develops job plans for assigned subordinates to communicate responsibilities and expected outcomes of performance in their role.
Develops strategies and objectives for assigned program areas to enhance performance and improve organizational efficiency.
Develops strategies for addressing staffing and headcount needs to ensure adequate coverage for assigned workload.

Documenting/Recording Information:

Continually documents the performance of assigned subordinates to ensure accurate and unbiased performance evaluations.
Documents investigations performed for employee relations purposes to ensure accurate information is used in decision making.

Identifying Objects, Actions, and Events:

Identifies changes to policies to update standard operating procedures and ensure that the team's work is in compliance with the most current standards.
Identifies work priorities to ensure the most important work is completed first based on work experience, supervisor guidance, and departmental, state, and federal laws, rules, regulations, and guidelines.

Making Decisions and Solving Problems:

Selects job candidates who best fit available positions based on the results of selection assessment and testing.
Approves, directly or tacitly, all transactions completed by assigned subordinates to ensure accuracy and compliance with standards.
Approves or denies performance evaluations on behalf of the appointing authority to ensure compliance with standards.

Evaluating Information to Determine Compliance with Standards:

Audits transactions completed by assigned subordinates to ensure accuracy and compliance with standards prior to approval.
Evaluates production of assigned subordinates to ensure accuracy and that production standards are met.
Evaluates candidate and employee qualifications to determine compliance with minimum qualifications and/or necessary and special qualifications.

Interpreting the Meaning of Information for Others:

Interprets a variety of current rules, regulations, policies, procedures, and documentation for internal and external business partners to facilitate understanding, enhance communications, and ensure compliance.
Explains program specific procedures and regulations to persons in other departments or divisions, or outside organizations and representatives, as required.

Monitoring Processes Materials or Surroundings:

Monitors error reports for accuracy.
Reviews the work of assigned subordinates to provide assistance and guidance on proper order and completion.
Monitors time and labor during each pay period to identify timekeeping issues and exceptions.
Monitors production quotas for assigned subordinates to ensure that required quotas are met.

Judging the Qualities of Things, Services, or People:

Assesses the performance of assigned subordinates to inform the performance evaluation process.
Assesses the quality of the work of assigned subordinates to inform advice and guidance related to performance management and development.
Assesses employee disciplinary and per.

Read the full job description and apply online on the recuiter's web-site

MANAGED CARE PROGRAM MANAGER 1

MANAGED CARE PROGRAM MANAGER 1

Find Jobs Hiring Now Near You!

Get Jobilize Job Search Mobile App Now

Related Job Postings

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

OB/GYN Needed for Locum Tenens Coverage at Facility in Pulaski, Tennessee

Thoracic Surgery Physician Assistant Needed for Locum Tenens Coverage at Facility in Eastern

Family Nurse Practitioner / Physician Assistant at Ascension Saint Thomas Urgent Care - FT/PRN

CDL Driver A

Pathology

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Drivers / Earn Up To $100K Yearly / 6 Mos. EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL Driver A

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd

CDL-A Flatbed OTR Drivers 85K 101K Yearly / 3 Months EXP Req'd City