MANAGED CARE PROGRAM MGR 1 - 02032026- 74813
 State of Tennessee | |||||||||||||||
$4,562.00 - $6,825.00 / month
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remote work
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 United States, Tennessee, Nashville | |||||||||||||||
| 1616 Church Street (Show on map) | |||||||||||||||
 Feb 03, 2026 | |||||||||||||||
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Job Information State of Tennessee Job Information
LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, TENNCARE DIVISION, DAVIDSON COUNTY 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 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 1. Works in partnership with TennCare's business areas and TennCare's MCOs to translate Medicaid program requirements into contract language and deliverables. Provides oversight and accountability of the MCOs in meeting TennCare's needs. 2. Develops job plans for assigned subordinates to communicate responsibilities and expected outcomes of performance in their role, strategies and objectives for assigned program areas, and strategies for addressing staffing and headcount needs to ensure adequate coverage for assigned workload. Explains program specific procedures and regulations to persons in other departments or divisions, or outside organizations and representatives, as required. 3. Leads assigned subordinates in conflict resolution; developing and maintaining constructive and cooperative working relationships with others; monitoring and reviewing information; identifying the educational needs of others; developing trainings; and scheduling events, programs, and activities, as well as the work of others. 4. Makes recommendations for changes in operations, efficiency and quality of agency operations and services. Analyzes production results over time to identify trends for staffing purposes and to ensure that enrollees receive the best possible services. 5. Monitors and controls resources and oversees spending. Monitors the healthcare providers in each MCO's network to ensure that each MCO has enough providers in its network to provide timely access to care for all members. 6. Recruits, interviews, selects, hires, and promotes employees in an organization. Schedules personal workload and the workloads of assigned subordinates. 7. Resolves disciplinary actions and interpersonal conflicts between assigned subordinates to ensure a respectful and productive work environment. Completes performance evaluation documentation for all assigned subordinates. 8. Contacts vendors and other outside agencies to obtain/provide required information, correct errors, and/or for clarification purposes. Communicates with outside callers to obtain/provide required information, correct errors, and/or for clarification purposes. Competencies (KSA's) Competencies:
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Skills:
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Tools & Equipment
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