MANAGED CARE SPECIALIST 1 - 08182026-79991

Location: Nashville, Tennessee – Department of Health, Davidson County (2 positions). This is a hybrid role requiring a criminal background check.

Qualifications

Education and Experience: Graduation from an accredited college or university with an associate's degree.

• Qualifying professional experience related to administrative, customer service, and/or data entry positions in health, healthcare, casework, or insurance settings may substitute for education (e.g., one year of experience = one year of education, up to two years).
• One year of full-time work with the State of Tennessee as a Managed Care Technician or in a similar role may substitute for education.

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

Overview

This role involves conducting telephonic outreach via outbound calls from the Tennessee Department of Health Call Center to families who have had a baby within the last four weeks. The specialist will follow a script to conduct a survey and help families identify their needs.

Responsibilities

• Evaluates provider enrollment status to determine approval and participation in the Medicaid program.
• Identifies standard or emergency appeals by timelines to ensure timely processing and issue resolution.
• Obtains information from enrollees, medical facilities, providers, and/or managed care organizations to complete enrollment processes and identify program issues.
• Analyzes contractor data to ensure accuracy and functional performance.
• Evaluates information to identify compliance issues and ensure program adherence.
• Documents, stores, and monitors enrollee and/or provider information in electronic databases or physical forms to maintain accuracy.
• Interprets Medicaid program specifics and division operations for internal/external partners to facilitate understanding and relationships.
• Networks with internal/external business partners and maintains open dialogue.

Skills

• Competencies: Nimble learning, decision quality, conflict management, action orientation, interpersonal savvy.
• Knowledge: Customer and personal service, clerical tasks, administration and management, education and training.
• Abilities: Active learning and listening, critical thinking, reading comprehension, time management, monitoring, deductive reasoning, speech recognition, written comprehension, speech clarity, oral expression.
• Tools & Equipment: Personal computer, telephone, fax machine, printer.

Pay

Monthly: $2,896.00 - $4,331.00
Annual: $34,752.00 - $51,972.00

Schedule

Full-time.