Member Support Coordinator

Job not on LinkedIn

🔥 2 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Serve as a key point of contact for individuals seeking information about the CHOICES program • Help members and family representatives understand available services and navigate the screening and referral process • Conduct CHOICES screenings telephonically • Manage incoming referrals and engage with members and authorized representatives by phone • Gather information and assess potential program eligibility • Educate individuals about available LTSS options • Ensure timely progression through the screening process • Interface with BlueCare internal departments and external partners to assist with enrollments, admissions and transitions, nursing facility diversion, discharge planning, Population Health coordination, D-SNP coordination, and service delivery or provider concerns • Research concerns and requests using clinical knowledge and expertise and assist in resolving problems and issues • Obtain, review, and assess reports including 834, ERC services, non-members with authorizations, expiring authorizations, daily inpatient census, and MIPPA reports • Disseminate clinical review results and collaboration requests to appropriate internal departments or Dual Special Needs Programs • Review LTSS requests and required documents and manage referrals, screenings, medical and educational records, enrollment, transitions, discharge planning, coordination, reassessments, cost of care, admissions/discharges, evaluations, authorizations, and disenrollments • Submit completed requests and supporting documents to TennCare PAE and tracking system, TennCare LTSS Operations, or Maximus • Monitor dispositions and communicate them to appropriate personnel

🎯 Requirements

• Must live in the State of Tennessee • Must hold a Masters in Social Work (LCSW, LMSW, or LAPSW) OR Registered Nurse (RN) OR Licensed Practical Nurse (LPN) license • 3 years of 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

🏖️ Benefits

• Fully remote role • Employee position