Associate Counsel

Minimum Annual Salary

$

03/02/2026

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.

Tenn Care 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. Tenn Care 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 Tenn Care with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

Tenn Care'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 work collaboratively to improve organizational processes in order to make a difference in the lives of our members. Because of the positive impact Tenn Care has on the lives of the most vulnerable Tennesseans, Tenn Care employees report that their work provides them with a sense of meaning, purpose, and accomplishment.

Tenn Care leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Executive Service

ASSOCIATE COUNSEL

Division of Tenn Care

Chief Medical Office (CMO)

Nashville, TN

Tenn Care operates under a managed care model, partnering with 5 managed care contractors, called MCCs. The 5 MCCs consist of 3 managed care organizations (MCOs), a dental benefit manager (DBM), and a pharmacy benefit manager (PBM). Operating our program under a managed care model allows us to align payment incentives with performance goals and better equips our agency with the tools we need to contain cost while promoting high quality care for our enrollees.

When a Tenn Care MCC makes an adverse benefit determination affecting one of their assigned Tenn Care enrollees, the enrollee has the right to appeal the determination to Tenn Care. Two units together process all medical, dental, and pharmacy appeals, the Appeals Processing Unit (APU) and Office of Fair Hearing (OFH). The Appeals Processing Unit hosts the appeal call center and completes the intake and processing of a medical member appeal.

If Tenn Care upholds the MCC's determination, agreeing that the benefit‑under‑appeal is not medically necessary under Tenn Care rules, then OFH is responsible for setting the enrollee's appeal for an administrative hearing, and for representing Tenn Care at the hearing. The OFH is a close‑knit, collegial team comprised of about 10 attorneys and 20 legal support staff. Most hearings are conducted remotely, with the judge, the witnesses, and the parties (the Tenn Care pro se enrollee/enrollee's representative and the assigned OFH attorney) each appearing separately by telephone or virtually.

• Appeals Representation: Represent the Division in appeals regarding denied medical services. Engage with Tenn Care enrollees, legal services attorneys, private counsel, and other stakeholders involved in appeals.
• Case Management: Direct Legal Assistants in gathering necessary case information, including documents generated by the Division, Managed Care Contractors, enrollees, health providers, witnesses, and hearing exhibits. Ensure completeness and accuracy of all case‑related documentation.
• Database Management: Update and maintain the appeals tracking database to reflect the current status and details of cases. Provide regular updates and reports to ensure compliance and efficiency.
• Hearing Preparation: Oversee the preparation of hearing exhibits, including collection, organization, and submission. Inform witnesses of hearing procedures and coordinate their participation. Review all drafts of case pleadings, including affidavits, motions, subpoenas, and other legal documents, to ensure accuracy and adherence to…