MANAGED CARE CONTRACT ADMINISTRATOR - 60809

Executive Service

MANAGED CARE CONTRACT ADMINISTRATOR

Division of TennCare

Managed Care Operations (MCO)

Nashville, TN

Salary : Minimum Monthly Salary $5,591 / month 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.

Closing Date : 09 / 09 / 2024

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 requires a 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 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 1.7 million Tennesseans and operates with an annual budget of approximately $14 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 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 :

This position is a part of the Managed Care Operations team, which is a division within TennCare of approximately thirty employees focused on providing oversight of TennCare's managed care entities to ensure contract compliance, program integrity, and operational efficiency.

Managed care is Tennessee's health care delivery system arrangement where 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 to monitor any fraud, waste, and abuse activities.

The MCO Contract Administrator will be a critical part of the Managed Care Operations team and will report directly to the Director of Managed Care Contracts.

This is a highly technical position that must lead the continuous life-cycle of contract development, procurement, and amendment.

This position serves two key roles :

This position will work alongside the Managed Care Contracts team to manage the lifecycle of drafting and editing TennCare's managed care MCO contracts, inclusive of 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.

The position will lead oversight and program management of TennCare's contract with Tennessee's Department of Children's Services (DCS).

Children in state custody are insured via TennCare, and this position will be required to build and maintain relationships with both TennCare stakeholders and DCS personnel alike to ensure that contract requirements and service delivery standards are being met.

Key Responsibilities :

• Lead the agency's contract oversight of the interagency agreement between TennCare and the Tennessee Department of Children's Services (DCS), including but not limited to serving as a subject matter expert (SME);
• Leading meetings between TennCare, DCS, external contractors, and healthcare providers;
• Approving billing methodologies and rate setting; and developing documentation such as policies, procedures, key performance indicators, and corrective action plans to facilitate contract compliance.
• Lead the agency's effort in drafting and amending the managed care MCO contracts, including soliciting content from business owners to be added to the contract, and writing with minimal direction the definitions and scope of work sections of the contract.
• Demonstrate a strong understanding of the contract requirements to deliver recommendations to business owners on what contract sections require clarification, additions, or deletions, as well as to review existing contract language and proposed contract language for compliance with state and federal statutes and regulations.
• Develop and demonstrate a comprehensive knowledge of TennCare's Medicaid and CoverKids programs, and lead the processing of Managed Care Contractor (MCC) and Dual-Special Needs Plan (DSNP) member material, including routing member materials to TennCare business units for review and composing TennCare's response to the MCC or DSNP regarding any discussion of changes to member materials.
• Ensure that all managed care contracts are well-maintained and remain organized and accessible to all parties; contract maintenance includes promoting positive business relationships and effectively communicating with TennCare's internal and external stakeholders, which may include collaborating with TennCare's General Counsel and TennCare's Director of
• Managed Care Contracts to submit the Contract Amendment to Tennessee's Fiscal Review Committee
• Serve as a subject matter expert (SME) and liaison between TennCare and the Centers for Medicare and Medicaid Services (CMS), especially when responding to CMS inquiries about managed care contract

Minimum Qualifications :

• Bachelor's Degree in English, Business Administration, Public Administration, or Contract Management and 5 years of experience as listed below.
• Experience in contract, legal, or related work
• Experience drafting and amending contracts including writing contract language and writing requests for proposals Or an equivalent combination of education and work experience may be considered.

Desired Qualifications :

• Master of Business Administration and 3 years of relevant professional experience; or Juris Doctorate and 3 years of relevant professional experience.
• Experience in children's services such as child welfare services, child protective services, or child social services is preferred (but not required)
• Advanced proficiency in Microsoft Word and Microsoft Office Suite (e.g., Excel, etc.)
• Advanced proficiency in Adobe editing tools and document comparison functionality

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.