VENDOR OPERATIONS LTSS HELP DESK MANAGER

Executive Service VENDOR OPERATIONS LTSS HELP DESK MANAGERDivision of TennCareMember Services - Vendor Operations Group (VOG)Nashville, TNSalary: Minimum Monthly Salary $5,050/month Closing Date: 11/04/2024 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. 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 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 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 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 Conduct audits of phone calls, tasks, chats, and documents in support of Contract service level agreements 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 Conduct monthly conferences timely and utilize the required written format 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 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 professional 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. Desirable qualifications: Demonstrated team lead experience may substitute management/supervision experience. 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 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.