Appeals Litigation Specialist Director

Executive Service 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.

Division of Tenn Care
, Member Services
, Nashville, TN

Minimum Annual Salary: $67,764.00

Closing Date: 08/31/2026

Tenn Care is Tennessee's Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, Tenn Care operates under the oversight of 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 worked collaboratively to improve organizational processes in order to make a difference in the lives 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.

Tenn Care compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy

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

The Division of Tenn Care is seeking a Tenn Care Eligibility Director in the Appeals Operation Group within Member Services. The Appeals Litigation Preparation Director will provide operational oversight and leadership to the Appeals Operations Group. They will work under the immediate supervision of the Tenn Care Litigation Appeals Administrator. This position will be indirectly supervising Legal Assistants as well as Tenn Care Program Coordinators and directly supervising Tenn Care Program Manager 2s.

The Appeals Litigation Preparation Unit prepares appeals for administrative hearing, reviews, and processes eligibility when appropriate, and testifies on behalf of the Division of Tenn Care  Appeals Litigation Preparation Director will develop unit goals, priorities, objectives, and strategies. Additionally, the Director will ensure communication and action plans are developed efficiently and effectively implemented within their area of responsibility. The Director will collaborate with the Appeals Litigation Director to develop and implement quality assurance measures;

ensure problem solving and decision-making processes are utilized to maximize the efficiency of the appeals litigation process; and monitor the risk and quality of all aspects of the appeals litigation process. Lastly, the Appeals Litigation Preparation Director must maintain a current knowledge base of policy and regulations surrounding Medicaid.

• Supervise four Program Manager 2s and indirectly supervise twenty-eight Appeal Coordinators, Legal Assistants, and other worker level staff
• Acquire and maintain a thorough understanding of Medicaid statutes, regulations, and policies
• Identify issues affecting eligibility determinations and appeals and propose remedial measures.
• Develop team goals, priorities, objectives, and strategies for staff
• Ensure all appeals are processed within the designed time frame given by monitoring, assessing, and addressing the team's overall performance
• Oversee the ongoing team specific training efforts and manage the performance process including goal evaluation and document initial, interim, and annual reviews
• Effectively communicate with, and aid, colleagues and Tenn Care members and applicants as needed
• Provide on-going coaching and…