WAIVER PROGRAMS CASE MAINTENANCE SPECIALIST - 10272026- 81989

State of Tennessee; Nashville (TN); Híbrido; USD 37.000 - 45.000; Jornada completa

Descripción de la vacante

State of Tennessee in Nashville is seeking a highly skilled Managed Care Specialist for TennCare. Under general supervision, you will perform highly technical TennCare program work, review applications, determine eligibility, and support enrollment.

You will mentor staff, use proprietary systems, handle inquiries, and coordinate with vendors and internal teams to ensure accurate benefits eligibility and timely service. A hybrid work arrangement is available.

Formación

• Bachelor's degree or Associate's degree with two years of qualifying professional experience in administrative, customer service and/or data entry positions related to policy, eligibility within health or healthcare, casework, or insurance settings.
• Experience substitution: up to four years of qualifying work may substitute for the required education.
• Two years of full-time work as a Managed Care Specialist with the State of Tennessee.
• A valid motor vehicle operator's license may be required.

Responsabilidades

• Determining Eligibility
• Reviewing individual applicant applications and enrollee income, resources and other technical elements
• Register applications as needed
• Make changes to member eligibility, establish eligibility
• Process reports to maintain accurate member caseloads
• Trouble shoot and respond to inquiries regarding member eligibility.
• Demonstrate strong customer service skills, interpretation of public policy, and problem solving
• Use proprietary computer-based systems to perform work duties
• Respond to emails, telephone calls, and other correspondence in a timely fashion
• Customer Service/Time Management
• Work with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base
• Be adept at dealing with ambiguity
• Manage time and prioritize tasks
• Ask for guidance and training as needed
• Strive to improve professional skills through continuous learning
• Exercise professional judgment to know when to elevate concerns
• Communication
• Remain up to date on new policies and procedures
• Explain eligibility for benefits and services
• Interpret policy to ensure understanding
• Explain enrollee responsibilities clearly
• Training: mentor staff and conduct required training
• Continually learn to better support peers and customers.

Conocimientos

Active Learning and Listening

Complex Problem Solving

Judgment and Decision MakingMonitoring

Time Management

Educación

Bachelor's or Associate's degree with related experience

Herramientas

Personal Computer

Telephone

Fax Machine

Printer

Descripción del empleo

State of Tennessee Job Information

Opening Date/Time 10/27/2026 12:00AM Central Time

Job Information

State of Tennessee Job Information

Opening Date/Time 10/27/2026 12:00AM Central Time

Closing Date/Time 11/09/2026 11:59PM Central Time

Salary (Monthly) $3,667.00

Salary (Annually) $44,004.00

Job Type Full-Time

City, State Location Nashville, TN

Department TennCare

LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, DAVIDSON COUNTY

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

Qualifications

Education and Experience: Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.

Substitution of Experience for Education: Qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).

Substitution of Experience for Education: Two years of full-time work as a Managed Care Specialist with the State of Tennessee.

Necessary Special Qualifications: A valid motor vehicle operator's license may be required.

Overview

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.

Under general supervision, is responsible for highly technical professional TennCare program work of considerable difficulty and/or supervisory work of average difficulty; and performs related work as required. This is the highly technical professional or supervisory class in the Managed Care Specialist sub-series. An employee in this class performs highly technical TennCare program work or supervises a small to moderate sized unit of Managed Care Specialists and/or sub professional staff performing TennCare duties. This class differs from Managed Care Specialist 2 in that an incumbent of the latter performs TennCare program work of average difficulty and is not responsible for highly technical or supervisory work.

Responsibilities

• Determining Eligibility
• Responsible for reviewing individual applicant applications and enrollee income, resources and other technical elements
• Register applications as needed
• Make changes to member eligibility, establish eligibility
• Process reports to maintain accurate member caseloads
• Trouble shoot and respond to inquiries regarding member eligibility.
• Demonstrate strong customer service skills, interpretation of public policy, and problem solving
• Use proprietary computer-based systems to perform work duties
• Respond to emails, telephone calls, and other correspondence in a timely fashion
• Customer Service/Time Management
• Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base. This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues
• Be adept at dealing with ambiguity
• Manage time and have the ability prioritize tasks.
• Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training
• Strive to improve professional skills and knowledge through continuous learning to better support peers and customers.
• Exercise professional judgment to know when to elevate a concern or issue
• Communication
• Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.
• Ensure accurate and clear communications
• Explain eligibility for benefits and services
• Interpret policy and procedure in relation to the enrollee's circumstances to ensure the member or applicant's understanding
• Communicate the enrollee/applicant's responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant's understanding.
• Training
• Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required.
• Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field.

Competencies (KSA's)

• Manages Complexity
• Organizational Savvy
• Directs Work
• Communicates Effectively
• Instills Trust

Knowledge

• Communication and Media
• Administration and Management
• Customer and Personal Service
• Law and Government
• Education and Training

Skills

• Active Learning and Listening
• Complex Problem Solving
• Judgment and Decision MakingMonitoring
• Time Management

Abilities

• Written Comprehension
• Inductive Reasoning
• Speech Clarity
• Oral Expression
• Problem Sensitivity

Tools & Equipment

• Personal Computer
• Telephone
• Fax Machine
• Printer