DIRECTOR OF MANAGED CARE OPERATIONS - 81963

State of Tennessee; Nashville (TN); Hybrid; USD 140,000 - 190,000; Full time

Job summary

TennCare is seeking a Director of Managed Care Operations to lead the executive team and provide strategic direction for the managed care delivery system. The role focuses on contract oversight, program integrity, and performance excellence across TennCare's MCOs.

The Director will manage approximately 36 employees across four teams, drive continuous improvement, and collaborate with agency leadership to advance TennCare's strategic priorities and operational performance.

Qualifications

• 5+ years of relevant professional experience in budget, finance, health care, government, or related areas.
• Equivalent combination of education and work experience may be considered in place of degree.
• Demonstrated ability to lead cross-functional teams and manage complex programs.
• Strong organizational skills with the ability to prioritize and meet tight deadlines.
• Experience with Medicaid or state government programs is preferred.

Responsibilities

• Provide strategic direction for Managed Care Operations (MCOps) and TennCare's executive leadership team.
• Oversee contract oversight, program integrity, and performance metrics for MCOs.
• Lead high-profile, cross-functional initiatives to improve operational performance.
• Translate data into actionable insights for executive decision-making.
• Develop and monitor performance goals and dashboards for key MCO activities.
• Manage a large, multi-team organization and foster a high-performing culture.
• Represent TennCare in interactions with legislators, providers, and stakeholders.

Skills

Analytical thinking

Oral and written communication

Project management

Leadership

Education

Bachelor's degree in business, finance, public administration, public health, public policy, or related field

Job description

Executive Service

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.

Executive Service

Director of Managed Care Operations

Division of TennCare

Managed Care Operations (MCO)

Nashville, TN

Closing Date: 11/02/2026

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

This position serves as a key member of TennCare's Executive Leadership Team and plays a central role in shaping and advancing the agency's strategic direction. In partnership with other executive leaders, the Director provides enterprise-level leadership, contributes to the development of agency priorities, and leads the execution of complex initiatives that support TennCare's mission, operational performance, and long‑term goals.

Further, the position serves as the Director of Managed Care Operations (MCOps), the division responsible for providing strategic oversight of TennCare's managed care delivery system and ensuring accountability among the managed care entities with which TennCare contracts. The division's work is focused on promoting contract compliance, program integrity, operational excellence, and strong performance across TennCare's managed care programs. TennCare operates through a managed care delivery model in which the State contracts with managed care organizations (MCOs) to coordinate and deliver health care services to TennCare members. The Director provides executive leadership for TennCare's oversight of these organizations and is accountable for ensuring that managed care operations align with the agency's strategic, programmatic, and operational priorities.

The Director is responsible for helping to set the vision and strategic direction for Managed Care Operations; driving innovation and continuous improvement; strengthening oversight, accountability, and performance management; and translating TennCare's strategic priorities into effective and sustainable operational practices. The Director routinely leads high‑profile, cross‑functional initiatives, navigates complex operational and policy issues, advises executive leadership on matters affecting the managed care program, and develops strategies to improve performance, mitigate risk, and enhance service delivery for TennCare members and providers.

The Director leads, develops, and provides strategic direction to approximately thirty‑six (36) employees across four teams and is responsible for fostering a high‑performing, collaborative, and accountable organizational culture.

TennCare delivers 100% of its Medicaid and CHIP medical services through managed care contracts overseen by MCOps. Valued collectively at approximately $10 billion annually, these are the largest contracts in Tennessee state government and are critical to TennCare's ability to administer its programs effectively.

The Director of MCOps is responsible for ensuring strong oversight, contract compliance, and accountability while partnering with MCOs to support successful program execution. The Director also serves as a key TennCare representative, engaging with agency leaders, MCO executives, legislators, providers, advocates, and other stakeholders to address complex operational issues and advance strategic priorities. Overall, this role will have opportunities to have meaningful impact on important decisions and the overall direction of TennCare in fulfilling its ultimate vision of a healthier Tennessee.

Key Responsibilities

• Manage a team responsible for MCO contract construction and compliance monitoring, program integrity, operational aspects of MCOs, and non‑emergency medical transportation.
• Develop a strong understanding of and provide guidance on high‑impact MCO operational requirements, including claims processing, provider contracting, reimbursement methodologies, and other areas with significant financial or member impact.
• Use operational, financial, utilization, quality, and performance data to identify trends, assess risks, evaluate MCO performance, and inform strategic and operational decision‑making.
• Partner closely with TennCare leadership and staff to assess the operational and financial impact of policy decisions, using available data and analysis to develop recommendations and lead or support implementations requiring MCO involvement.
• Establish and maintain relationships with key partners, including MCOs, other state departments, external providers, and stakeholder organizations.-Lead special projects related to MCO operations.
• Provide operational oversight of Tennessee's Children's Health Insurance Program (CHIP), which is integrated into the MCO contracts, and TennCare Select, a separate contract serving specialized populations.
• Analyze proposed legislation for operational and fiscal impact on MCOs and TennCare, incorporating quantitative analysis and relevant program data, and support Executive Leadership in legislative hearings.
• Establish, implement, and monitor performance‑based goals for key MCO operational activities; develop and use meaningful metrics, dashboards, and trend analyses to evaluate performance, identify areas requiring intervention, and measure improvement.
• Ensure MCO subcontractor and vendor compliance and monitor key performance indicators to evaluate service delivery, identify emerging issues, and drive corrective action, including for services such as non‑emergency medical transportation (NEMT).
• Translate complex data and performance information into clear, actionable insights and recommendations for executive leadership, internal teams, MCOs, and other stakeholders.
• Promote a culture of continuous improvement by using data to evaluate the effectiveness of operational strategies, identify opportunities for greater efficiency and accountability, and inform changes to managed care requirements and oversight practices.
• Provide relevant, timely, and accurate communications to MCOs regarding updates or changes to the TennCare program.

Minimum Qualifications

• A bachelor's degree in business, finance, public administration, public health, public policy, or other related field from an accredited college or university and 5+ years of relevant professional experience in budget, finance, health care, government, or other related areas.
• An equivalent combination of education and work experience may be considered in place of degree.

Desirable Qualifications

• A master's degree in business, finance, public administration, public health, public policy, or other related field from an accredited college or university or a Juris Doctorate (JD).
• Direct experience working for a state Medicaid agency that utilizes managed care.
• Experience with healthcare contract procurements (e.g., Requests for Information, Requests for Proposals, etc.).
• Experience with Tennessee's legislative process (e.g., conducting bill analysis, drafting Fiscal Note Support Forms, etc.).
• Experience with health insurance claims and encounter data analysis and processing.
• Project management experience 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.
• Demonstrated problem‑solving skills with a track record in creating business processes and improving existing ones.
• Strong operational skills, including translating high‑level goals to detailed tasks and following them through to completion.
• Strong computer skills, including expert proficiency in Microsoft Office applications, especially Word and Excel.
• Demonstrated ability to effectively manage internal teams and external contractors.
• Strong oral and written communication skills, with a demonstrated ability for concise and effective communication.
• 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.