Special Programs Eligibility Specialist - 10132026-81678

State of Tennessee Job Information Opening Date/Time 10/13/2026 12:00AM Central Time Closing Date/Time 10/26/2026 11:59PM Central Time Salary (Monthly) $3,667.00 Salary (Annually) $44,004.00 Job Type Full-Time City, State Location Nashville, TN Department Tenn. Care LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, DAVIDSON COUNTY 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

Education and Experience

Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.

Substitution of Experience for Education: Qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting may substitute for the required education to a maximum of four years (e.

g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education). Substitution of Experience for Education: Two years of full-time work as a Managed Care Specialist with the State of Tennessee. Necessary Special Qualifications: A valid motor vehicle operator's license may be required.

The Division of Tenn. Care is dedicated to providing our employees with a hybrid work environment. All Tenn. Care 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. Under general supervision, is responsible for highly technical professional Tenn.

Care program work of considerable difficulty and/or supervisory work of average difficulty; and performs related work as required. This is the highly technical professional or supervisory class in the Managed Care Specialist sub-series. An employee in this class performs highly technical Tenn. Care program work or supervises a small to moderate sized unit of Managed Care Specialists and/or sub professional staff performing Tenn.

Care duties. This class differs from Managed Care Specialist 2 in that an incumbent of the latter performs Tenn. Care program work of average difficulty and is not responsible for highly technical or supervisory work.

Determining Eligibility: Responsible for reviewing individual applicant applications (i.e.: Breast and Cervical Cancer, Former Foster Care, Children leaving Foster Care, and Emergency Medical Services and enrollee income, resources and other technical elements Register applications as needed Process Special Programs related eligibility tasks.

This includes priority task from DCS i.e.: Children entering foster care Monitor queues and production Process reports to maintain accurate member caseloads Trouble shoot and respond to inquiries regarding member eligibility. Demonstrate strong customer service skills, interpretation of public policy, and problem solving Use proprietary computer-based systems to perform work duties Respond to emails, telephone calls, and other correspondence in a timely fashion Customer Service/Time Management Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base.

This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues Be adept at dealing with ambiguity Manage time and attendance Prioritize tasks Make corrections on cases that have identified errors and perform case reviews as needed to provide additional to management and other stakeholders Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training Exercise professional judgment to know when to escalate a concern or issue Communication Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.

Attend Staff meetings with peers and one on one meetings with superiors Ensure accurate and clear communications Explain eligibility for benefits and services Interpret policy and procedure in relation to the enrollee's circumstances to ensure the member or applicant's understanding Communicate the enrollee/applicant's responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant's understanding.

Training Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required. Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field. Strive to improve professional skills and knowledge through continuous learning to better support peers and customers.

Competencies: Manages Complexity Organizational Savvy Directs Work Communicates Effectively Instills Trust Knowledge: Communication and Media Administration and Management Customer and Personal Service Law and Government Education and Training Skills: Active Learning and Listening Complex Problem Solving Judgment and Decision Making Monitoring Time Management Abilities: Written Comprehension Inductive Reasoning Speech Clarity Oral Expression Problem Sensitivity

Personal Computer Telephone Fax Machine Printer