ASSISTANT DIRECTOR OF MANAGED CARE OVERSIGHT - 80421

Executive Service ASSISTANT DIRECTOR OF MANAGED CARE OVERSIGHT Division of TennCare Managed Care Operations (MCO) Nashville, TN Minimum Annual Salary: $78,528.00 Closing Date: 09/14/2026 Background Check 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 Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, TennCare operates under the oversight of 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 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 The Assistant Director of Managed Care Oversight serves as a senior member of the Managed Care Oversight team and will report directly to the Managed Care Oversight Director. This role has no direct reports, instead it is responsible for managing projects that require collaboration, alignment, and guidance of others' work to ensure successful outcomes. The Assistant Director will carry out strategic goals, operational oversight, and performance improvement efforts. This role exercises independent judgment, leads project workstreams, and partners with the Director to set strategic direction across a team of three staff. Further, the Assistant Director is responsible for data-driven performance monitoring, high-level issue resolution, and strengthening TennCare's oversight of MCO provider-related functions. This role regularly represents the Managed Care Oversight team in internal and external meetings. Key Responsibilities • Strategic Leadership & Team Support • Serve as a strategic partner to the Managed Care Oversight Director in setting vision, priorities, and annual goals for the Managed Care Oversight team. Independently lead cross-functional workgroups consisting of leadership from other TennCare departments, TennCare's MCOs, and external stakeholders such as professional associations (e.g., Tennessee Medical Association (TMA), Tennessee Hospital Association (THA), Tennessee Association of Mental Health Organizations (TAMHO), Tennessee Association for Home Care (TAHC), Tennessee Health Care Association (THCA), Rural Health Associations (RHAT), etc.) to research and problem solve emerging issues with the operations of TennCare's MCOs. • Assist the Managed Care Oversight Director with the development, maintenance, and revision of the respective multi-year strategic plans specific to Non-Emergency Medical Transportation (NEMT), • School-based Services (SBS), and Managed Care Oversight. • Data Analysis, Reporting, & Decision Support • Serve as the primary liaison between the Planning Analysts in the Managed Care Oversight team and TennCare's Business Relationship Management (BRM) and TennCare's Information Systems (IS) teams, ensuring that Managed Care Oversight's business needs are met during complex project implementations. • Create a comprehensive dashboard for TennCare's Executive team to have visibility to TennCare's MCO's operational performance (e.g., including metrics for timeliness of credentialing; timeliness of contracting; network adequacy; timeliness of payment; accuracy of payment; and timeliness in reaching a decision for provider appeals and grievances). • Provide technical support to the Planning Analysts in their design of dashboards, trend analyses, and monthly/quarterly reporting of TennCare's MCOs' performance according to benchmarks and contract requirements. • Design PowerPoint presentations to communicate patterns, risks, or emerging issues observed in data shared between TennCare and its MCOs and make recommendations to address known issues. • Assist Planning Analysts with data analysis and interpretation using the data received in each analysts' respective report deliverables. • Prepare data sets or create reports on an ad-hoc basis as requested by the Director of Managed Care Oversight. • MCO Performance Oversight & Accountability • Serve in lieu of the Director of Managed Care Oversight in hosting MCO accountability meetings with each of TennCare's business owners that have programmatic responsibility according to the MCO contracts. • Collaborate with TennCare business owners to evaluate MCO performance and collaborate on strategies to strengthen MCO accountability by refining contract requirements. This may involve drafting contract language or using MCO tools of accountability (e.g., writing requests for information (RFIs), on request reports (ORRs), notification of intent to assess Liquidated Damages (LDs), or requests for the MCO to provide a corrective action plan (CAP)). • Take primary responsibility for specific projects as assigned, providing proactive oversight with minimal direction. • Policy, Compliance & Special Initiatives • Respond to inquiries from CMS, HHS, and/or OIG and provide those responses to the Director of Managed Care Oversight for review ahead of final submission (e.g., Prior Authorization federal reporting; Payment Transparency reporting; EVV reporting; etc.). As requested by the Managed Care Oversight Director, research and create policy briefs concerning how other U.S. states are handling programs efforts in non-emergency medical transportation, school-based services, or managed care. • Draft frequently asked questions (FAQs), training presentations, or other media as needed to communicate changing state and federal policy, as well as to aid MCO compliance with implementing program requirements set forth by state and federal laws. • Help lead the Managed Care Oversight team through major policy changes, as assigned. Minimum Qualifications • Bachelor's Degree in Business Administration, Public Administration, or Contract Management and 7 years of experience as listed below; or Master of Business Administration and 5 years of experience as listed below • Experience in contract management and/or vendor management • Experience with performing audits and drafting audit reports. OR • an equivalent combination of education and work experience may be considered. Desirable Qualifications • A bachelor's degree in business, public administration, public health, public policy, or other related field from an accredited college or university • 3+ years of relevant professional experience in health administration, health insurance, Medicaid managed care, or other related areas • Direct experience working for a state Medicaid agency that uses managed care OR direct experience working for a Medicaid managed care organization • Experience with health insurance claims and encounter data analysis and processing • Experience with non-emergency transportation benefits • Experience with school-based services initiatives and strategy • Experience with healthcare contract procurements (e.g., requests for information, requests for proposals, etc.) and/or contract accountability (e.g., sanctions, corrective action plans, etc.) • Formal project management background or training • Strong analytical skills, with a demonstrated ability to recognize patterns and trends in data and to find answers to complex questions and problems • Strong oral communication and concise and effective written communication skills, with a demonstrated ability for conflict mediation and resolution, customer service, and delivering policy directives or corrective action plans. • Demonstrated experience independently leading complex projects, workstreams, or initiatives. • Strong computer skills including expert proficiency in Microsoft Office applications, especially Word, PowerPoint, and Excel • Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines 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.