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Director, Dual Eligible Operations and Initiatives | TennCare | Nashville, TN

  • TennCare
  • , TN

This position has been filled.

TennCare is Tennessee’s Medicaid managed care program that provides health insurance coverage for 1.4 million low-income children, adult caretakers of children, pregnant women and disabled adults.  TennCare currently covers over one out of every five Tennesseans, half of all Tennessee births, and has an annual budget of $11 billion. TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994.  It is the only program in the nation to enroll the entire state Medicaid population in managed care.

Position Overview

TennCare is seeking a Medicare expert to serve as the Director of Dual Eligible Operations and Initiatives and lead all aspects of program operations pertaining to members eligible for Medicare and Medicaid (Dual Eligibles). The Director will report to the Deputy of Quality Administration and work alongside the Executive team to manage all aspects of Dual Eligible operations. This role will oversee Medicaid payment for Medicare co-insurance and cost sharing. In addition, this role will plan, implement and lead alignment and integration initiatives to improve the quality and cost-effectiveness of care for dual eligible members.

Qualifications

  • A Bachelor’s degree from an accredited college or university required.
  • A minimum of five years of experience in Medicare Advantage (preferably SNP) program operations, possessing expertise in Medicare and/or Medicaid managed care regulations and policy.
  • A background in Medicare benefits, coding and payment, care coordination, and related content.
  • A knowledge of Medicare that spans strategy, operations, and policy.
  • Self-motivation with a project management mindset and an ability to work within a complex organization.
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