MANAGED CARE CONTRACT ADMINISTRATOR - 28585

MANAGED CARE CONTRACT ADMINISTRATOR

Division of TennCare

Managed Care Operations (MCO)

Nashville, TN

Minimum Monthly Starting Salary: $5,259
Exceptions for higher compensation may be considered based on education and experience in accordance with Department of Human Resources (DOHR) policy.

Closing Date: 03/29/2022

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 1.6 million Tennesseans and operates with an annual budget of approximately $12 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 work 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.

How you make a difference in this role:

This position is a part of the Managed Care Operations team, which is a division within TennCare of approximately twenty-five employees focused on facilitating high-quality and cost-effective manage care and program integrity within Tennessee's Medicaid program. "Managed care" is Tennessee's health care delivery system arrangement where the Tennessee's Medicaid program (TennCare) contracts with health insurance companies known as managed care organizations (MCOs) to deliver health care services to TennCare members. The Managed Care Operations team's role is to work in partnership with TennCare's business areas and TennCare's MCOs to translate Medicaid program requirements into contract language and deliverables. This contract development and amendment process is a continuous process where language is refined in order to improve the contract agreement. This process also exists to closely monitor contract deliverables to ensure that program requirements are being met and that fraud, waste, and abuse are not occurring.

This MCO Contract Administrator will be a critical part of the Managed Care Operations team and will report directly to the Assistant Director of the Managed Care Operations division. This is a highly technical position that must lead the continuous life-cycle of the MCO contract's development, procurement, and amendment. This cycle involves the drafting and editing of TennCare's managed care contract, writing contractor risk agreements, and any associated manuals or protocols. TennCare's programmatic operations rests on the efficacy of the contract language between TennCare and its managed care contractors. Similarly, the integrity of the agency's contract documents is paramount to the efficiency and effectiveness of TennCare's benefits coverage and TennCare's MCOs' ability to deliver health care services to TennCare Members.

Key Responsibilities:

Minimum Qualifications:

Education:

• Bachelor's Degree in English, Business Administration, Public Administration, or Contract Management and 5 years of experience as listed below; or
• Master of Business Administration and 3 years of experience as listed below; or
• Juris Doctorate and 3 years of experience as listed below

Experience:

• Experience in contract, legal, or related work
• Experience drafting and amending contracts including writing contract language and writing requests for proposals

Skills:

• Advanced proficiency in Microsoft Word including multi-level list, headers, bullets, numbering, tables, and document design functionality, as well as document review functionality such as track changes, markup, comments, and comparison features
• Advanced proficiency in Adobe editing tools and document comparison functionality
• Candidate must be detail oriented, organized, skilled at balancing competing priorities to meet deadlines
• Excellent verbal and written communication skills and experience with engaging with leaders at all levels (including executive leaders in government, corporate suites, and nonprofit entities)

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.