Managed Care Specialist

Managed Care Specialist (Bilingual) – Hybrid

Location: Nashville, TN (Hybrid) Work Schedule: Monday–Friday | 8:00 AM – 4:30 PM CST | 37.5 hours/week Duration: 12-Month Contract (Extension Possible) Start Date: July 20, 2026 Work Authorization: Must be authorized to work in the U.S. Local Requirement: Candidates must reside in Middle Tennessee and be able to commute to the Nashville office as needed. Language Requirement: Bilingual candidates are required.

Position Overview

We are seeking a detail-oriented and customer-focused Managed Care Specialist to join our Member Services team in a hybrid work environment. This role is responsible for determining program eligibility, managing case documentation, supporting legal and administrative processes, and providing exceptional customer service. The ideal candidate is organized, analytical, and able to manage multiple priorities while maintaining accuracy and professionalism.

The position includes an extensive training program consisting of up to six weeks of virtual and onsite instruction. Attendance is mandatory throughout the training period, and no preplanned PTO will be approved during these weeks.

Key Responsibilities

• Determine eligibility for individuals and families seeking managed care and related assistance programs.
• Conduct interviews with clients to gather and verify information required for case processing.
• Maintain accurate case files, documentation, and records while ensuring timely case resolution.
• Coordinate schedules and communicate effectively with internal teams, external stakeholders, and clients.
• Assist with legal and administrative support activities, including reviewing legal documents, conducting research, and preparing documentation when necessary.
• Analyze information and provide recommendations based on collected case data.
• Navigate multiple databases and information systems to retrieve, update, and maintain client records.
• Participate in team meetings, workgroups, and departmental initiatives.
• Support supervisors and leadership with additional administrative or operational tasks as assigned.
• Deliver high-quality customer service while maintaining confidentiality and compliance with organizational policies.

Required Qualifications

• Associate's or Bachelor's degree from an accredited institution.
• Strong verbal and written communication skills.
• Excellent organizational, time management, and multitasking abilities.
• Strong analytical, critical thinking, and problem-solving skills.
• High level of accuracy and attention to detail.
• Proficiency with Microsoft Office Suite, including: Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint, SharePoint.
• Ability to work independently with minimal supervision while meeting established deadlines.
• Ability to learn and effectively use multiple databases and software applications.
• Bilingual communication skills (required).

Preferred Qualifications

• Educational background in Paralegal Studies.
• Experience working in a legal office or legal support environment.
• Previous customer service or call center experience.
• Experience working with managed care, healthcare administration, Medicaid, TennCare, or other government benefit programs.
• Experience handling case management, eligibility determination, or member services.

Preferred Skills

• Client interviewing and information gathering
• Case management and documentation
• Eligibility determination
• Legal research and document preparation
• Data entry and database navigation
• Customer service excellence
• Professional written correspondence
• Time management and prioritization
• Collaboration and teamwork
• Problem-solving and critical thinking

Work Environment

• Hybrid work arrangement with both remote and onsite work based on business needs.
• Office located in Downtown Nashville, Tennessee.
• Standard office hours: Monday through Friday, 8:00 AM – 4:30 PM CST.
• Extensive onboarding and training program (up to six weeks), requiring full attendance.

Additional Information

• Contract Length: 12 months with potential for extension.
• No duplicate candidate submissions.
• No preplanned PTO will be approved during the required training period.
• Candidates must be local to Middle Tennessee and able to report onsite when requested.