Member Support Coordinator

Description

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

• Masters in Social Work (LCSW, LMSW, or LAPSW) OR Registered Nurse (RN) OR Licensed Practical Nurse (LPN)
• 3 years - Clinical experience required
• 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 :

Must reside in the state of Tennessee.

Must be able to come onsite for quarterly team meetings in Nashville.

Flexible shift hours, potential to start as early as 6am Central Time.

Must be comfortable communicating over the phone.

Experience with documentation review, preferred.

Experience with Long Term Services and Support, preferred.

Preferred Skills :

Number of Openings Available :

Worker Type : Employee

Employee

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 :

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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.