Hybrid Renewal Operations Manager

State of Tennessee; Nashville (TN); Hybrid; USD 55,000 - 62,000; Full time

Job summary

State of Tennessee in Nashville seeks a Senior Manager to oversee TennCare’s eligibility operations. You will supervise a team using the TEDS system to process renewals, applications, and changes, ensuring accurate determinations and contract compliance.

You will lead process improvements, coach staff, and coordinate with the Eligibility Director. The role emphasizes collaboration, performance coaching, and timely decision-making in a hybrid work environment.

Qualifications

• Bachelor's degree and five years of professional level experience interpreting policy or procedural provisions for TennCare/Medicaid or related health insurance organization, including one year drafting contractual requirements or supervising professional staff.
• Substitution of Experience for Education allows up to four years substitute for the required education.
• Four years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, and/or Managed Care Division Director with the State of Tennessee, with one year at the Managed Care Specialist 3 or higher.

Responsibilities

• Supervise a team of Managed Care Specialists who will utilize the TennCare Eligibility Determination System (TEDS) to process renewals, applications, and case changes to determine eligibility for all TennCare programs based on Financial and Non-Financial criteria.
• Apply advanced knowledge of TennCare's business processes and policies to daily work operations
• Provide support and guidance to staff on matters relating to Medicaid rules, regulations, policies and procedures
• Conduct weekly team meetings to provide timely information regarding processes, initiatives, directives, and training opportunities
• Provide clear and concise verbal and written communication and guidance to staff in a positive manner
• Ensure all tasks are processed within the designated timeframe by monitoring, assessing, and addressing the team's overall performance
• Navigate, process, and troubleshoot renewals, applications, and case changes with TennCare's Tennessee Eligibility Determination System (TEDS)
• Remain up to date on new policies and procedures as they are implemented to ensure accurate eligibility determinations
• Monitor staff production and quality by reviewing team performance reports and performing five case reads per Managed Care Specialist
• Conduct regular coaching and guidance to ensure staff meet goals set forth by the agency and in compliance with TennCare policy and following established business processes
• Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of opportunity are resolved in a positive manner
• Utilize Edison to monitor leave balances, approve/deny leave requests and approving payable time
• Conduct monthly conferences timely and utilize the required written format
• Utilize the SMART formula to evaluate/rate employee performance throughout the performance review cycle
• Build team morale to ensure staff have a positive and inclusive work environment; which leads to higher job satisfaction, and results in greater team efficiencies and effectiveness
• Ensure that staff communicate with applicants, members, families, and Authorized Representatives to relay clear information and expectations of the information needed for an accurate eligibility determination.
• Work collaboratively and proactively with the TennCare Eligibility Director to identify areas of concern and create continuous quality and process improvement plans
• Lead the end-to-end onboarding experience, ensuring new team members have the clarity, resources, and support needed for a successful transition.

Skills

Active Learning and Listening

Critical Thinking

Speaking

Management of Personnel Resources

Complex Problem Solving

Education

Bachelor's degree

Tools

TEDS

Edison

Job description

State of Tennessee in Nashville seeks a Senior Manager to oversee TennCare’s eligibility operations. You will supervise a team using the TEDS system to process renewals, applications, and changes, ensuring accurate determinations and contract compliance.

You will lead process improvements, coach staff, and coordinate with the Eligibility Director. The role emphasizes collaboration, performance coaching, and timely decision-making in a hybrid work environment.