State of Tennessee
WAIVER PROGRAMS ELIGIBILITY SPECIALIST - 71885
State of Tennessee, Nashville, Tennessee, United States, 37247
Executive Service – Waiver Programs Eligibility Specialist
Division of TennCare – Member Services – Eligibility Operations Group (EOG)
Nashville, TN
Salary: Minimum Monthly Salary $4,057/month - competitive compensation based on education and experience, in accordance with DOHR policy.
Closing Date: 10/27/2025
Hybrid Work Environment TennCare provides a hybrid work model combining work from home and office. Work locations vary by position, department, and business need. Review specific expectations with the hiring team.
Background Check Criminal background check required. Applicants may need to disclose criminal history.
Who We Are and What We Do TennCare is Tennessee's Medicaid managed care program covering low‑income individuals including pregnant women, children, caretakers, older adults, and adults with disabilities. TennCare serves approximately 1.7 million Tennesseans with an annual budget of about $14 billion. Oversight is provided by the Division of TennCare with funding and guidance from CMS. TennCare’s mission is to improve lives by delivering high‑quality, cost‑effective care. Employees report meaningful purpose, accomplishment, and professional development priority.
Job Overview The Division of TennCare seeks a Waiver Programs Eligibility Specialist in the Eligibility Operations Group within Member Services. The role reports to an Eligibility Operations Group Manager and processes TEDS applications to determine eligibility for Institutional Medicaid. The Specialist works with customers, families, facilities, and Authorized Representatives to provide clear information and documentation for accurate eligibility determination. Actions are documented in TEDS and other systems when necessary.
Key Responsibilities
Review documents and make eligibility determinations in accordance with rules, regulations, policies, and guidelines.
Process Medicaid applications timely according to established policies and regulations.
Provide support and guidance to assigned staff on Medicaid rules, regulations, policies, procedures, and organizational databases.
Evaluate production to ensure accuracy and meet production standards.
Provide and participate in training, resources, and tools to enhance performance and professional development of staff.
Deliver excellent customer service to internal and external stakeholders.
Minimum Qualifications Education and Experience:
Bachelor’s degree from an accredited college or university, preferred in business administration, management, public health, health policy, paralegal, or legal assistant studies, plus at least 2 years of relevant work experience.
OR
Equivalent combination of education and work experience may be considered.
Desirable Qualifications
Graduation from an accredited university with a bachelor’s degree in business administration, management, public health, or health policy and either:
Four (4) years of experience within TennCare.
Four (4) years of experience within a Medicaid, managed care, or healthcare organization.
Ability to foster and maintain cohesive working relationships.
Ability to adapt to changing priorities and deadlines.Ability to exercise sound judgment.
Strong organizational skills, including prioritization, multi‑tasking, and workload management to meet timeframes and deadlines.
Advanced writing and communication skills.
EEO Statement Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is committed to fair and equal employment opportunities and protects the rights and opportunities of all people to seek, obtain, and hold employment without discrimination or harassment. The State policy provides an environment free of discrimination and harassment based on 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.
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Division of TennCare – Member Services – Eligibility Operations Group (EOG)
Nashville, TN
Salary: Minimum Monthly Salary $4,057/month - competitive compensation based on education and experience, in accordance with DOHR policy.
Closing Date: 10/27/2025
Hybrid Work Environment TennCare provides a hybrid work model combining work from home and office. Work locations vary by position, department, and business need. Review specific expectations with the hiring team.
Background Check Criminal background check required. Applicants may need to disclose criminal history.
Who We Are and What We Do TennCare is Tennessee's Medicaid managed care program covering low‑income individuals including pregnant women, children, caretakers, older adults, and adults with disabilities. TennCare serves approximately 1.7 million Tennesseans with an annual budget of about $14 billion. Oversight is provided by the Division of TennCare with funding and guidance from CMS. TennCare’s mission is to improve lives by delivering high‑quality, cost‑effective care. Employees report meaningful purpose, accomplishment, and professional development priority.
Job Overview The Division of TennCare seeks a Waiver Programs Eligibility Specialist in the Eligibility Operations Group within Member Services. The role reports to an Eligibility Operations Group Manager and processes TEDS applications to determine eligibility for Institutional Medicaid. The Specialist works with customers, families, facilities, and Authorized Representatives to provide clear information and documentation for accurate eligibility determination. Actions are documented in TEDS and other systems when necessary.
Key Responsibilities
Review documents and make eligibility determinations in accordance with rules, regulations, policies, and guidelines.
Process Medicaid applications timely according to established policies and regulations.
Provide support and guidance to assigned staff on Medicaid rules, regulations, policies, procedures, and organizational databases.
Evaluate production to ensure accuracy and meet production standards.
Provide and participate in training, resources, and tools to enhance performance and professional development of staff.
Deliver excellent customer service to internal and external stakeholders.
Minimum Qualifications Education and Experience:
Bachelor’s degree from an accredited college or university, preferred in business administration, management, public health, health policy, paralegal, or legal assistant studies, plus at least 2 years of relevant work experience.
OR
Equivalent combination of education and work experience may be considered.
Desirable Qualifications
Graduation from an accredited university with a bachelor’s degree in business administration, management, public health, or health policy and either:
Four (4) years of experience within TennCare.
Four (4) years of experience within a Medicaid, managed care, or healthcare organization.
Ability to foster and maintain cohesive working relationships.
Ability to adapt to changing priorities and deadlines.Ability to exercise sound judgment.
Strong organizational skills, including prioritization, multi‑tasking, and workload management to meet timeframes and deadlines.
Advanced writing and communication skills.
EEO Statement Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is committed to fair and equal employment opportunities and protects the rights and opportunities of all people to seek, obtain, and hold employment without discrimination or harassment. The State policy provides an environment free of discrimination and harassment based on 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.
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