MANAGED CARE TECHNICIAN - 08182026-80055

Location: Nashville, TN (Hybrid). This position requires a criminal background check.

Qualifications

Education and Experience:

• Education equivalent to graduation from a standard high school.
• Two years of clerical and/or customer service experience, of which one year must be in TennCare, Medicaid, Managed Care, or any other related health insurance organization.
• Substitution of Experience for Education: Qualifying clerical and/or customer service experience may substitute for the required education (e.g., one year of full-time work in the listed fields may substitute for one year of required education).
• One year of full-time work as a Managed Care Operator with the State of Tennessee may substitute for the above requirements.

Necessary Special Qualifications: None.

Overview

Under general supervision, this role involves TennCare technical work of average difficulty. An employee in this class assists professional Managed Care specialists in performing a variety of TennCare program assignments, including research, claims processing, report development, program planning, and evaluation. This role also functions as a lead worker to Managed Care Operators.

Responsibilities

• Communicating with Persons Outside Organization: Represent the organization to customers, the public, government, and other external sources via in-person, written, telephone, or email communications.
• Interpreting Information: Explain program rules, regulations, policies, procedures, and documentation to internal and external partners to ensure compliance and enhance understanding.
• Guiding and Directing Subordinates: Provide guidance and monitor team performance to ensure timely task completion.
• Decision-Making and Problem-Solving: Analyze internal and external information to evaluate results and choose optimal solutions.
• Process Improvement: Develop suggestions to streamline workflows, improve cycle times, and enhance accuracy.
• Training and Teaching: Identify educational needs, develop training programs, and instruct others.
• Administrative Tasks: Maintain information files and process paperwork.
• Coordinating Work: Align workloads with internal and external partners to ensure timely and accurate task completion.
• Compliance Evaluation: Assess data input, reports, and performance documents for accuracy and adherence to policies and standards.
• Coaching and Development: Identify developmental needs and mentor team members to improve skills and knowledge.
• Monitoring Processes: Audit data input and coworker performance to meet departmental goals and ensure accuracy.
• Technical Documentation: Draft instructions for assembling electronic or mechanical devices.
• Conflict Resolution: Handle complaints, disputes, and grievances, or negotiate with others to resolve conflicts.
• Customer Service: Provide service to internal and external customers to maintain positive relationships and outcomes.
• Performance Evaluation: Assess subordinate or peer performance according to policies and assist supervisors in the evaluation process.
• Equipment Inspection: Address equipment, material, or environmental issues to maintain a functional workspace.
• Documentation: Record audits, data entry, and performance evaluations to ensure accurate decision-making.
• Work Organization: Develop goals and plans to prioritize, organize, and accomplish tasks efficiently.
• Consultation: Provide expert advice to management or other groups on technical, systems, or process-related topics.
• Team Building: Foster mutual trust, respect, and cooperation among team members.
• Data Analysis: Analyze internal and external data for workflow planning, accuracy, and compliance with policies.
• Influencing Others: Promote program benefits and team services to internal and external contacts.
• Knowledge Updates: Attend agency-specific training to comply with departmental, state, and federal laws.
• Computer Interaction: Use office productivity software (e.g., word processing, spreadsheets, email, search engines) to complete tasks.
• Information Gathering: Receive applications, data, policies, and updates from various sources to enroll providers and members in services.
• Scheduling: Consult with peers and subordinates to streamline task completion.
• Interpersonal Relationships: Develop and maintain constructive, cooperative working relationships over time.
• Policy Compliance: Identify policy changes to update standard operating procedures and ensure compliance.
• Internal Communication: Share information with supervisors, peers, and team members via multiple channels.
• Data Processing: Calculate, categorize, and tabulate applications, enrollments, and tasks to generate reports for supervisors.
• Equipment Maintenance: Repair minor office equipment issues or report them to the appropriate staff.

Skills

• Competencies: Intellectual horsepower, learning on the fly, problem-solving, informing, priority setting, time management, standing alone, perseverance, composure, integrity, trust, listening, approachability, boss relationships, written communication.
• Knowledge: Clerical, customer and personal service, education and training, law and government.
• Skills: Active listening, critical thinking, learning strategies, reading comprehension, speaking, writing, instructing, persuasion, complex problem-solving, judgment/decision-making, time management.
• Abilities: Deductive reasoning, information ordering, memorization, oral comprehension, time sharing, written comprehension, dynamic flexibility, hearing sensitivity, speech clarity, speech recognition.

Tools & Equipment

• Personal Computer
• Telephone
• Fax Machine
• Printer
• Copier/Scanner
• Other related office equipment

Pay

Monthly: $2,581.00 - $3,870.00
Annually: $30,972.00 - $46,440.00

Schedule

Full-Time

Driver Requirements

State of Tennessee positions involving driving require:

• A valid driver’s license.
• No record of the following violations in the past five years: DUI, reckless driving, license suspension for moving violations, or more than 4 moving violations.

Include your Driver’s License Information under the Licenses and Certifications section of your application. Exceptions may be allowed based on other factors.