Managed Care Specialist

Overview

Location: Nashville, TN/Hybrid - Candidate Must Be Local

Duration: 6+ months

Work Type: Hybrid

Tenn Care will recruit a new classification for MANAGED CARE PROGRAM MGR.

This Contractor position is critical to accomplishing LTSS  Team outcomes related to ensuring that the 1915(c) and Select Community programs are operating at maximum performance and ensuring that upcoming federal reporting and waiver renewal/amendment deadlines are met.

• Assist the  Team in conducting continuous analysis and evaluation of frequent and recurring reports/deliverables/related contract amendments to enhance program improvement.
• Complete 1915(c) post-payment Utilization Reviews.
• Update/analyze/validate federally mandated 1915(c) quality data on a monthly basis.
• Contribute to the upcoming (c) waiver renewals through careful review and collaboration.

• Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to 3 years of professional level experience.
• Excellent Excel skills and experience with all other Microsoft Office Programs.
• Experience interpreting policy or procedural provisions for a Tenn Care, Medicaid, or other related health insurance organization is preferred.
• Excellent written and oral communication skills

• Passion and commitment to supporting people with I/DD, person-centered practices, and integrated employment and community living
• Experience with program management and/or grant management
• Experience in contract management
• Experience working in or with Medicaid or disability related programs
• Strong work ethic and self-motivated with ability to work well on a team
• Organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific time frames and deadlines
• Ability to adapt to changing priorities and deadlines