DIRECTOR OF OFFICE OF FAIR HEARINGS AND POST-HEARING APPEALS AND DIRECTIVES - 78382

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.

Key Responsibilities

• Lead ongoing operational compliance and serve as TennCare's subject matter expert for fair hearing and post-hearing appeals requirements
• Interpret and apply TennCare rules, federal CMS regulations, the Tennessee Uniform Administrative Procedures Act, applicable civil procedure and evidentiary standards, and related contractual requirements
• Lead the development and revision of TennCare policies, rules, and operational procedures governing medical appeals and hearings
• Ensure all hearing and post-hearing logistics and operational procedures are consistent and timely
• Lead quality improvement initiatives to support member and team experience
• Provide strategic legal guidance and risk assessment to executive leadership regarding complex appeals, regulatory developments, litigation-related matters, and high-profile or precedent-setting cases
• Oversee compliance with Managed Care Contractor contractual obligations, Independent Medical Review requirements, and other applicable regulatory and accreditation standards
• Partner with TennCare leadership and external stakeholders to address operational, legal, and policy issues related to appeals and hearings
• Advise OFH/Post legal team and provide recommendations related to appeals operations, legal risk, policy implications, and program performance
• Build and maintain collaborative relationships with key internal and external stakeholders including TennCare and CMO senior leadership, Managed Care Contractors, the Administrative Procedures Division, CMS, and other governmental partners
• Represent TennCare in executive-level meetings, interagency collaborations, audits, regulatory reviews, and other forums involving appeals and hearing operations
• Prepare and present executive-level briefings, recommendations, reports, and strategic analyses that support informed decision-making and organizational accountability
• Lead workforce development and organizational change efforts that strengthen the effectiveness of OFH and Post-Hearing Appeals operations
• Provide coaching, mentorship, performance management, and leadership support for legal assistants, attorneys, managers, and operational leaders
• Support workforce planning, recruitment, onboarding, employee engagement, leadership development, corrective action, and retention strategies
• Lead organizational change initiatives through stakeholder engagement, communication planning, training, and performance monitoring while promoting a collaborative workplace focused on accountability, continuous learning, innovation, and operational excellence

Minimum Qualifications

• A current, valid license to practice law in Tennessee or be eligible for licensure under Tennessee Supreme Court Rule 7, Article X
• 3+ years of supervisory experience
• 3+ years of relevant legal experience OR an equivalent combination of education and work experience may be considered

Desirable Qualifications

• Coursework and/or demonstrated understanding of administrative law and the Tennessee Uniform Administrative Procedures Act
• Demonstrated understanding of managed care, federal Medicaid regulations, the TennCare program or TennCare's member medical appeal process
• Exceptional written and oral advocacy skills, as evidenced by legal experience or participation in law review, law journal, or moot court during law school
• Ability to work collaboratively with a legal team and manage multiple priorities in a fast-paced environment
• Experience with administrative litigation skills and/or expertise in Medicaid managed care law