AUDITS MANAGER - 76796

Executive Service

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. You may review the specific expectations with our hiring team.

Background Check:

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview:

Long-Term Services and Supports (LTSS) is one of the largest units within TennCare with a team of highly capable staff who are committed to leading the ongoing development and operation of an innovative, sustainable, person-driven long-term services and supports (LTSS) system in which older adults and people with disabilities and/or chronic conditions have choice, control and access to a full array of high-quality services and supports that assure optimal outcomes, including independence, health and quality of life.

The MC Program Manager 2 leads the planning, management, and execution of LTSS audit activities. This role oversees a small audit team responsible for overall audit planning through final audit presentation, and ensures that audit processes support compliance monitoring, informed decision-making, and program improvement. The ideal candidate has experience in contract auditing, procurement, financial oversight, managed care operations, and/or program compliance. They are comfortable synthesizing information, interpreting contract requirements, and communicating clearly with a variety of stakeholders.

Key Responsibilities:

• Lead the design, ongoing refinement, and execution of LTSS audits, strategies, and work plans. This includes updating operations manuals and procedures as needed.
• Review and update audit protocols, processes, information requests, audit tools, and supporting documentation to ensure consistent and accurate monitoring of compliance and contractor performance.
• Collaborate with other teams to translate audit findings into actionable recommendations and track key performance improvements metrics.
• Monitor and oversee the receipt, tracking, review, and analysis of audit deliverables as specified in the LTSS policies and contracts for the MLTSS programs.
• Prepare, present, and provide relevant audit results and key findings for internal and external audiences through clear written, verbal, and visual communication.
• Contribute to the development of audit automation tools and dashboard to reduce administrative burden.
• Support and attend all LTSS stakeholder-related activities including participating in meetings and other events/activities related to the MLTSS programs, as needed.
• Serve as Performance Lead in the VM program for contracts assigned collaborating with LTSS program leads to ensure that vendor performance reporting is validated against contract terms.

Minimum Qualifications:

• Graduation from an accredited college or university with a bachelor's degree and experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization, of which two years must include drafting contractual requirements, developing rules and regulations, or supervising professional staff who deal with health insurance.

Substitution of Experience for Education:

• Five years of full-time work as a Managed Care Specialist, Managed Care Program Mgr, and/or Managed Care Division Director with the State of Tennessee, of which one year must be at the Managed Care Specialist 3 or higher level.

Desirable Qualifications

• Strong computer skills including Microsoft Office applications such as Excel, Word, and Power Point, and the capacity to learn other statistical software applications.
• Strong written and verbal communication and presentation skills, including technical writing; and the ability to communicate effectively with stakeholders.
• Skilled in critical thinking, conducting quality reviews of information, and providing input for system improvement (related to both quality of data and efficiency)
• Demonstrated ability to operate with minimal oversight and adhere to priorities set by supervisor
• Excellent organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines
• Flexibility to adjust plans based on new learning and/or changing program goals
• Experience managing and leading audits holding others accountable for work output
• Strong knowledge of TennCare LTSS programs
• Work experience in or with Medicaid, Managed Care, or other related health insurance organization or programs
• Experience with Yellow Book standards

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.