DIRECTOR OF OPERATIONS - 78957

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 OFH operations, systems, and process improvement efforts to ensure member medical appeals are processed timely, accurately, and consistently.
• Oversee daily operational work for OFH Logistics and Pleadings staff, including appeal deliverables, hearing logistics, docket coordination, and documentation.
• Establish clear timelines, expectations, and follow-up processes to support consistent appeal processing across OFH/Post.
• Cook up operational team meetings, agendas, action items, and communication across OFH, MMA, and key stakeholders.
• Lead OFH participation in MATS improvement efforts, including identifying, prioritizing, and tracking system change requests with MMA leadership, Deloitte, Acentra, MCO, and other stakeholders.
• Support development and use of dashboards, productivity reports, audit reports, and other tools to monitor workload, performance, appeal trends, and operational needs.
• Improve appeal tracking, scheduling, documentation, reporting, and staff workflows to strengthen efficiency and member experience.
• Identify workflow issues and elevate needs for additional guidance, escalation, or process improvement.
• Support workforce management, training, and staff development for OFH operational teams.
• Supervise and support OFH operational managers and staff responsible for logistics, pleadings, and related legal support functions.
• Support hiring, onboarding, training, coaching, performance management, corrective action, and staff development.
• Develop training materials, shadowing processes, guidance documents, and standard operating procedures.
• Ensure staff understand and use available systems, dashboards, reports, and tracking tools.
• Promote collaboration, team building, and employee engagement across OFH and MMA.
• Support professional development and cross-training opportunities to improve consistency, accountability, and continuity across OFH operations.
• Partner across MMA and with external stakeholders to support effective appeal operations.
• Collaborate with OFH attorneys, APU leadership, APD, Acentra, MCC partners, Deloitte, Member Services, and TennCare leadership to resolve appeal-process issues.
• Support coordination on docket maintenance, hearing scheduling, file documentation, medical review reporting, and other issues affecting the appeal lifecycle.
• Communicate operational updates, risks, recommendations, and process improvement needs to MMA and TennCare leadership.
• Lead or support special projects that improve OFH operations, appeal tracking, staff workflows, or the member experience.

Minimum Qualifications

• Bachelor's degree from an accredited college or university in related field (master's degree in health care field preferred - MBA, MPH, MPP, or MHA)
• AND 3+ years in similar role or in health care management or operations.
• Experience interpreting policy or procedural provisions for a related health insurance or provider organization is preferred.
• Experience in analyzing data and using data to drive performance and expectations.
• OR An equivalent combination of education and work experience may be considered.

Desirable Qualifications

• Ability to work collaboratively with a legal team and manage multiple priorities in a fast-paced environment.
• Experience with administrative litigation skills.