Member Support Coordinator- Nashville Area

PLEASE NOTE: This position is Remote with some geographic restrictions. To be hired for this position, you MUST live in one of the following states: Alabama (AL), Arkansas (AR), Florida (FL), Georgia (GA), Mississippi (MS), Missouri (MO), North Carolina (NC), South Carolina (SC), Tennessee (TN), Virginia (VA). The position works alongside HCBS, discharge, and institutional care/support coordinators to promote interdependent collaboration with the member, physician/primary care manager, family, and other members of the care/support coordination team to ensure continuity of care by performing activities as needed to support HCBS, discharge, transition of care from various institutional settings and collaborating directly with care/support coordinators. Job Description: BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate. 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) to provide assistance with community 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, 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 TPAES (PAE and tracking system), TennCare LTSS Operations or Ascend (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

Job Specific Requirements: Preferred Skills: Number of Openings Available: 0 Worker Type: Employee Worker Sub-Type: FlexHome Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to 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. All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate. Tobacco-Free Hiring Statement To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.