The LTSS Clinical Support Team at BlueCross BlueShield of Tennessee (BCBST) is seeking a Member Support Coordinator to join our growing team.

In this role, you will support the CHOICES program by screening program applicants, reviewing and validating documentation for submission into TennCare systems serving as a liaison for DSNP (Dual Special Needs Plan) -related requests and cross training for other tasks as assigned.

The position involves significant time spent working at a computer and conducting telephonic outreach with potential members. The primary responsibility is to complete CHOICES applicant screenings, along with other assigned duties, to ensure compliance with established timeframes and CRA requirements.

We are seeking candidates who demonstrate a high level of empathy, strong telephonic communication skills, and a genuine passion for helping others. The ideal candidate is detail-oriented, dependable, and motivated by making a meaningful impact on members’ lives every day. If this sounds like your next role, please apply!

Experience with PERLSS, Agent Workspace, Maximus, Care Advance, CHOICES and TennCare Connect is preferred.

This is a non–member-facing position and does not require travel. All candidates must reside in the state of Tennessee.

Job Responsibilities

• Provides an interface for BlueCare internal departments, (UM, Appeals, Population Health, BlueCare plus, etc) and external partners (other MCOs, Division of TennCare, providers, D-SNPs, Maximus, DCS, DIDD) to provide assistance with enrollments, admissions and transitions, NF diversion, discharge planning, Population Health coordination, D-SNP coordination and assisting care coordinators in resolving concerns about service delivery or providers. MSC will research the concern/request in detail utilizing clinical knowledge/expertise and assist in resolving problems, issues, or complying with request.
• Obtain, review and assess reports including, but not limited to 834 for skilled services, ERC services, Non-members with Authorizations, Expiring Authorizations, Daily Inpatient Census and MIPPA Report. The results of clinical review and/or request for collaboration will then be disseminated to appropriate internal departments or Dual Special Needs Programs.
• Utilize clinical knowledge and expertise to review Long Term Services and Support (LTSS) requests and required documents, then manage requests to include referrals/screenings, obtaining medical and educational records, enrollment, transitions, discharge planning, Population Health coordination, Dual Special Needs Program (D-SNP) coordination, monitoring for Katie Beckett enrollments, annual reassessments and cost of care, nursing facility and hospital admissions/discharges, Complex Respiratory Care evaluations and ERC authorizations, and disenrollments from LTSS.
• The Member Support Coordinator is responsible for submitting appropriate completed requests and supporting documents to TennCare PAE and tracking system, TennCare LTSS Operations or Maximus (PASRR, level of care) and monitors for disposition that is then communicated to appropriate personnel.

Job Qualifications

Education

• Masters in Social Work (LCSW, LMSW, or LAPSW) OR Registered Nurse (RN) OR Licensed Practical Nurse (LPN)

Experience

• 3 years - Clinical experience required

Skills\Certifications

• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Exceptional time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• Adaptive to high pace and changing environment
• Must possess ability to maintain professional relationships with vendors and other external partners
• Ability to work independently on multiple tasks involving critical deadlines with little or no supervision as well as part of a team

Number of Openings Available

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.