DIRECTOR OF OPERATIONS - 78957

Executive Service

DIRECTOR OF OPERATIONS

Division of TennCare

Chief Medical Office (CMO)

Nashville, TN

Minimum Annual Salary $67,764.00

Closing Date: 08/03/2026

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 $19 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:

TennCare 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 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.

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system payment reform. TennCare's Medical Office is integral to this mission by leading clinical and quality oversight and strategic innovation for the agency. The medical office is responsible for all medical, dental, behavioral health and pharmacy policy, operations, and appeals as well as quality improvement and population health programming. When a TennCare Managed Care Contractor (MCC) makes an adverse benefit determination affecting one of their assigned TennCare enrollees, the enrollee has the right to appeal the determination to TennCare. If TennCare upholds the MCC's determination, agreeing that the benefit-under-appeal is not medically necessary under TennCare rules, then the enrollee's appeal is set for administrative hearing. The Office of Fair Hearings (OFH) & Post-Hearing Appeals and Directives (Post) consists of attorneys and legal support staff who facilitate the administration of administrative hearings. The Director of Operations plays a critical role in the seamless functioning of the unit by overseeing both the personnel and tools that its core activities.

Key Responsibilities:

• Lead OFH operations, systems, and process improvement efforts to ensure member medical appeals are processed timely, accurately, and consistently.
• Oversee daily operational work for OFH Logistics and Pleadings staff, including appeal deliverables, hearing logistics, docket coordination, and documentation.
• Establish clear timelines, expectations, and follow-up processes to support consistent appeal processing across OFH/Post.
• Coordinate operational team meetings, agendas, action items, and communication across OFH, MMA, and key stakeholders.
• Lead OFH participation in MATS improvement efforts, including identifying, prioritizing, and tracking system change requests with MMA leadership, Deloitte, Acentra, MCO, and other stakeholders.
• Support development and use of dashboards, productivity reports, audit reports, and other tools to monitor workload, performance, appeal trends, and operational needs.
• Improve appeal tracking, scheduling, documentation, reporting, and staff workflows to strengthen efficiency and member experience.
• Identify workflow issues and elevate needs for additional guidance, escalation, or process improvement.
• Support workforce management, training, and staff development for OFH operational teams.
• Supervise and support OFH operational managers and staff responsible for logistics, pleadings, and related legal support functions.
• Support hiring, onboarding, training, coaching, performance management, corrective action, and staff development.
• Develop training materials, shadowing processes, guidance documents, and standard operating procedures.
• Ensure staff understand and use available systems, dashboards, reports, and tracking tools.
• Promote collaboration, team building, and employee engagement across OFH and MMA.
• Support professional development and cross-training opportunities to improve consistency, accountability, and continuity across OFH operations.
• Partner across MMA and with external stakeholders to support effective appeal operations.
• Collaborate with OFH attorneys, APU leadership, APD, Acentra, MCC partners, Deloitte, Member Services, and TennCare leadership to resolve appeal-process issues.
• Support coordination on docket maintenance, hearing scheduling, file documentation, medical review reporting, and other issues affecting the appeal lifecycle.
• Communicate operational updates, risks, recommendations, and process improvement needs to MMA and TennCare leadership.
• Lead or support special projects that improve OFH operations, appeal tracking, staff workflows, or the member experience.

Minimum Qualifications:

• Bachelors degree from an accredited college or university in related field (master's degree in health care field preferred - MBA, MPH, MPP, or MHA) AND 3+ years in similar role or in health care management or operations.

• Experience interpreting policy or procedural provisions for a related health insurance or provider organization is preferred.

• Experience in analyzing data and using data to drive performance and expectations.

OR

• An equivalent combination of education and work experience may be considered.

Desirable Qualifications:

• Ability to work collaboratively with a legal team and manage multiple priorities in a fast-paced environment.

• Experience with administrative litigation skills

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.