Member Support Coordinator

Our Long-Term Services and Supports (LTSS) Clinical Support team is looking for a new Member Support Coordinator!

We are seeking a compassionate, organized, and member-focused Member Support Coordinator who is passionate about helping TennCare members access the long-term services and supports they need to remain safely and independently in their homes and communities. In this role, you will serve as a key point of contact for individuals seeking information about the CHOICES program, helping members and their family representatives understand available services and navigate the screening and referral process.

As part of our LTSS Clinical Support team, you will conduct CHOICES screenings telephonically, manage incoming referrals, and engage directly with members and their authorized representatives by phone. You will play an essential role in gathering information, assessing potential program eligibility, educating individuals about available LTSS options, and ensuring timely progression through the screening process. This position requires strong communication skills, attention to detail, and the ability to build trust with individuals who may be facing significant health, functional, or caregiving challenges.

To be successful in this role, you will need excellent customer service and organizational skills, the ability to manage multiple priorities in a fast-paced environment, and a commitment to delivering a positive member experience. This position is ideal for someone who enjoys helping others, thrives on meaningful member interactions, and is motivated by improving access to quality long-term services and supports for TennCare members across Tennessee.

Note:

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

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.