State of Tennessee
ASSISTANT COUNSEL-53309
State of Tennessee, Nashville, Tennessee, United States,
APPEALS LEGAL REVIEW ATTORNEY
Division of TennCare
Nashville, TN
Minimum Monthly Salary: $5,508/month
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.
Closing Date: 01/22/2024
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.
This position requires a criminal 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).
Job Overview
The Division of TennCare is seeking a Legal Review Attorney in the Appeals Operations Group within the Member Services. Under the general supervision of a Lead Attorney, a Legal Review Attorney will make a valid factual dispute determination on TennCare eligibility appeals. The Legal Review Attorneys will be responsible for in-depth case research as it relates to TennCare Medicaid Policy.
Key Responsibilities
Research and review appeals in TennCare's Tennessee Eligibility Determination System (TEDS) database and make a valid factual dispute determination.
Acquire and maintain a thorough understanding of Medicaid statutes, regulations, and policies.
Review and monitor cases and appeals to ensure they are processed in compliance with Medicaid statutes, regulations, and policies.
Identify issues affecting eligibility determinations and appeals and propose remedial measures.
Effectively communicate with, and provide assistance to, colleagues, management, and TennCare appellants as needed.
Minimum Qualifications
Bachelor's Degree from an accredited college or university.
Juris Doctor from an accredited college or university.
Active License to practice law in Tennessee.
Ability to foster and maintain cohesive working relationships.
Ability to adapt to changing priorities and deadlines.
Ability to exercise sound judgment.
Excellent organizational skills necessary, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
Excellent writing and communication skills.
Ability to interpret and execute public policy.
Desirable Qualifications
Knowledge of and experience with eligibility appeals procedures a plus.
Previous legal review experience a plus.
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.
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Division of TennCare
Nashville, TN
Minimum Monthly Salary: $5,508/month
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.
Closing Date: 01/22/2024
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.
This position requires a criminal 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).
Job Overview
The Division of TennCare is seeking a Legal Review Attorney in the Appeals Operations Group within the Member Services. Under the general supervision of a Lead Attorney, a Legal Review Attorney will make a valid factual dispute determination on TennCare eligibility appeals. The Legal Review Attorneys will be responsible for in-depth case research as it relates to TennCare Medicaid Policy.
Key Responsibilities
Research and review appeals in TennCare's Tennessee Eligibility Determination System (TEDS) database and make a valid factual dispute determination.
Acquire and maintain a thorough understanding of Medicaid statutes, regulations, and policies.
Review and monitor cases and appeals to ensure they are processed in compliance with Medicaid statutes, regulations, and policies.
Identify issues affecting eligibility determinations and appeals and propose remedial measures.
Effectively communicate with, and provide assistance to, colleagues, management, and TennCare appellants as needed.
Minimum Qualifications
Bachelor's Degree from an accredited college or university.
Juris Doctor from an accredited college or university.
Active License to practice law in Tennessee.
Ability to foster and maintain cohesive working relationships.
Ability to adapt to changing priorities and deadlines.
Ability to exercise sound judgment.
Excellent organizational skills necessary, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
Excellent writing and communication skills.
Ability to interpret and execute public policy.
Desirable Qualifications
Knowledge of and experience with eligibility appeals procedures a plus.
Previous legal review experience a plus.
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.
#J-18808-Ljbffr