APPEALS LITIGATION SPECIALIST MANAGER - 65143

Executive Service

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 do:

TennCare 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 Overview:

The Division of TennCare is seeking an Appeals Litigation Specialist Manager in the Appeals Operation Group within Member Services. Under the general supervision of the Appeals Litigation Specialist Director, the Appeals Litigation Specialist Manager will oversee a team of Litigation Specialists by providing support and guidance on matters relating to Medicaid rules, regulations, policies, procedures, and organizational databases. This position is responsible for ensuring their team of Litigation Specialists are prepared to represent the state at TennCare eligibility appeals proceedings. These proceedings require Litigation Specialists to act as state witnesses, perform legal research, update eligibility information, and organize and prepare files for hearings. To obtain a just outcome, the Litigation Specialists also work with Litigation Attorneys and Legal Assistants.

The Appeals Litigation Specialist Manager will ensure their staff effectively communicate with internal and external stakeholders to relay clear information. Additionally, this role will be responsible for monitoring system reports and productivity of their staff for timely process of appeals. The Appeals Litigation Specialist Manager will assist with unit goals, priorities, objectives and strategies as well as ensure communication and action plans are efficiently and effectively implemented within their area of responsibility. This position will work collaboratively and proactively with the Appeals Litigation Specialist Director to identify areas of concern and create continuous quality and process improvement plans. The Appeals Litigation Specialist Manager will have a working knowledge of case evaluation related to appeals of cases from internal and external partners. Lastly, the Appeals Litigation Specialist Manager must maintain a current knowledge base of policy and regulations surrounding Medicaid.

Key Responsibilities:

• Monitor the daily system reports to ensure all appeals are moving appropriately through the appeals process in a timely manner and be able to provide status to the Appeals Litigation Specialist Director or Appeals Litigation Director, as requested.
• Work with other Appeals Litigation Managers and the Appeals Litigation Lead Attorney for Appeals Litigation Managers and Appeals Litigation Specialists to monitor Appeals Litigation Specialists' particular skills, to include strengths and areas for growth, in an effort to ensure appeals are properly moving through the appeals process towards closure.
• Create strategies and plans to meet anticipated workloads. Structure team to be flexible so as to meet the changing demands in workload.
• Clearly and concisely express ideas and information in written and verbal communications (formal/informal), keeping these professional while maintaining a professional manner that aligns with TennCare's Mission and the Unit's Mission and Vision Statement and with the Unit's Core Values and internal policies.
• Take ownership of, and be accountable for, the consistency and accuracy of messages given to staff and demonstrate this by communicating information in a positive and professional Matter.
• Participate in all scheduled AOG meetings.
• Attend all supervisor meetings and trainings weekly, monthly, and yearly.
• Ensure all time, leave requests, and compensatory time requests are entered in Edison timely.
• Confirm that leave and compensatory requests are entered before time is reported.
• Timely document and respond to requests for leave, monitor and approve payable time and conduct all time and leave entries as required by Edison.
• Enforce applicable policies and procedures that relate to administrative functions (i.e., timeliness, dress code, code of conduct, etc.)
• Complete all Individual Performance Plans for team on the schedule provided by the State of Tennessee.
• Provide challenging and stretching tasks and assignments.
• Construct compelling development plants and execute them using the developmental system.
• Provide coaching to those who need help and further development. Connect employees with informal and formal development opportunities.
• Meet regularly for awareness of each AOG divisions' responsibilities and ensure collaboration between units for timely and efficient processing of appeals.
• Confer and coordinate with the Appeals Litigation Specialists, Appeals Litigation Lead Attorneys, Appeals Litigation Attorneys or with EOG managerial staff for a unified understanding of policy when applicable.
• Conduct biweekly team meetings to provide timely information regarding processes, initiatives, directives, and training opportunities and discuss staff ideas for continuous work process improvement.
• Conduct monthly observations and Q & A sessions individually with each member of the team.
• Routinely inform the Appeals Litigation Specialist Director of all activities within the group that are in the nature of trainings, skills evaluations, case preparation issues/concerns, team member issues, hearing issues/concerns, resource issues (i.e. the unavailability of tools necessary to complete work related tasks), or any other issue that in good conscience should be brought to the attention of the Litigation Director.
• Recognize and analyze process improvements that guarantee appeals are heard timely
• All unacceptable or marginal performance will be addressed with staff, at the time it occurs, both orally and in writing, and referenced on performance management documents. Any performance or conduct that warrants disciplinary action will be discussed with the Employee Relations staff in TennCare Human Resources prior to issuing discipline. Any notifications of possible or alleged violations of State policy/rules/laws will immediately be escalated to the Employee Relations staff in TennCare Human Resources.
  

Minimum 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 two years must include drafting contractual requirements, developing rules and regulations, or supervising staff who deal with health insurance.

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.

Examination Method: For Executive Service Positions, Minimum Qualifications, Necessary Special Qualifications, and Examination Method are determined by the appointing authority.

Desirable Qualifications

• Education equivalent to graduation from an accredited college, university, or professional school with one of the following (preferred): Bachelor's Degree in Paralegal or Legal Assistant studies; or Paralegal Certificate; or one year (28 semester hours) of graduate level law school
• 3 years of TennCare eligibility case processing knowledge
• Knowledge of the appeals continuum and policies/procedures
• Administrative hearing preparation and testifying experience
• Ability to adapt to changing priorities and deadlines
• Ability to foster and maintain cohesive working relationships
• Ability to interpret and execute policies and procedures
• Ability to exercise sound judgment
• Advanced organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
• Ability to identify the developmental needs of others and coaches, mentors, or otherwise helps others to improve their knowledge or skills
• Excellent writing and communication skills
  

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.