Managed Care Specialist

18 hours ago


Memphis, Tennessee, United States Ask IT Consulting Full time
Job Title: Managed Care Specialist

TennCare is seeking a highly skilled Managed Care Specialist to join our team. As a key member of our LTSS ID Services Team, you will play a critical role in ensuring the success of our 1915(c) and Select Community programs.

Key Responsibilities:
  • Conduct continuous analysis and evaluation of frequent and recurring reports/deliverables/related contract amendments to enhance program improvement.
  • Assist in conducting 1915(c) post-payment Utilization Reviews and update/analyze/validate federally mandated 1915(c) quality data on a monthly basis.
  • Contribute to the upcoming c) waiver renewals and ensure that all deadlines are met.
Requirements:
  • Graduation from an accredited college or university with a bachelor's degree and experience equivalent to 3 years of professional level experience.
  • Excellent Excel skills and experience with all other Microsoft Office Programs.
  • Experience interpreting policy or procedural provisions for a TennCare, Medicaid, or other related health insurance organization is preferred.
Desirable Qualifications:
  • Passion and commitment to supporting people with I/DD, person-centered practices, and integrated employment and community living.
  • Experience with program management and/or grant management.
  • Experience in contract management.
  • Experience working in or with Medicaid or disability related programs.
Location:

Candidate must be local. Additional location details: Nashville, TN.

Background Verification:

Minimum verification requirements: TN Package with TN Counties Criminal County/Statewide - 7 yr address, Conduct a county or statewide search where available.



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