BlueCross BlueShield of Tennessee

Manager

• Provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses
• Use a proactive, advocacy-driven approach to support members
• Collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes
• Support cost-effective utilization of services and reduce unnecessary ED and inpatient utilization
• Manage a dynamic caseload
• Support utilization management functions for more complex and non-routine cases as needed
• Serve as a liaison between members, providers, and internal/external customers in coordinating healthcare delivery and benefits programs
• Oversee highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits
• Perform case management activities including assessment, planning, implementation, coordinating, monitoring, outcomes, and evaluation
• Communicate via digital channels and offer technical support

RN Medical Case Manager

Care Coordinator

• Partner with members and families to identify supports and direct services for health, employment, independent living, and community living goals
• Collaborate with clinical and social support colleagues to address members’ physical, behavioral health, and long-term service needs
• Conduct thorough, objective face-to-face home or community visits
• Assess members’ physical, behavioral, functional, psychosocial, financial, employment, and independent-living needs
• Use authorization criteria to approve appropriate home- and community-based services
• Confirm authorized services are delivered and members’ needs are met
• Manage requests and demands from internal and external stakeholders
• Travel to members’ homes for visits

Supervisor

• Lead, mentor, and support a geographically dispersed team of Care Coordinators serving CHOICES members throughout Middle Tennessee
• Oversee daily operations and provide clinical and operational guidance
• Monitor staff performance, quality metrics, documentation standards, utilization benchmarks, and regulatory compliance
• Ensure members receive needed support and services to remain safely in their homes or nursing facilities
• Provide hands-on guidance for complex, high-profile, and escalated member situations
• Collaborate with providers, nursing facilities, community partners, and internal departments to address member needs and service gaps
• Coach and develop staff through training, case consultation, and performance management
• Assist with workforce planning, onboarding, workload balancing, and operational improvement initiatives
• Complete reports, audits, and deliverables accurately and on time
• Provide direct support during member crises, challenging family interactions, and critical care coordination situations
• Supervise, direct, and evaluate diverse health care professionals
• Communicate and mentor care coordination team members to ensure policies, procedures, and long-term and home- and community-based care guidelines are followed
• Periodically carry a caseload of members when required by census fluctuations or staffing coverage
• Travel throughout the Middle Tennessee region as business needs dictate

CHOICES Supervisor – Middle Grand Region

Pharmacist

• Support Medicare and D-SNP coverage review activities
• Build and manage cases with pharmacists and healthcare providers
• Contribute to coverage determinations affecting member care and health outcomes
• Engage with providers and manage multiple priorities
• Enter authorizations and test claims into the pharmacy benefit system
• Handle incoming and outgoing calls from providers, members, and member representatives
• Monitor and answer emails and FACETs inquiries regarding pharmacy reviews, appeals, and claims issues
• Review daily pharmacy reports to ensure appropriate claims processing
• Assist with departmental audits and quality improvement activities
• Work evenings, holidays, and weekends when required to ensure adequate coverage

Clinical Pharmacy Specialist

Engineer

• Analyze, design, develop, document, and implement complex solutions for end-user computing systems
• Provide highly available software distribution and patch management
• Monitor performance and maintain system stability
• Support and ensure reliability of deployed technologies, systems, and processes according to established procedures and industry best practices
• Develop software packages and deployment scripts
• Support Windows 11 environments and remediate workstation vulnerabilities
• Troubleshoot Microsoft Intune, Company Portal, and deployment issues
• Participate in maintenance and upgrades outside business hours and an on-call rotation

Client Engineer

Full-stack Engineer

• Support and modernize EDI, interoperability, and FHIR capabilities across batch and real-time processing
• Ensure underlying applications and servers remain reliable and secure
• Solve complex production challenges and improve systems through automation
• Work across on-premises, OpenShift, and cloud environments
• Formulate and define system scope and objectives through research and fact-finding
• Design, develop, modify, or integrate complex information systems
• Optimize application systems and procedures for capacity, operating time, response time, and desired results
• Design, code, test, debug, and document programs, subroutines, and scripts
• Develop and implement program/system test plans and data verification methods
• Respond to system failures and performance events to reduce downtime and prevent recurrence
• Research software and hardware products to support recommendations, budgeting, and purchasing
• Act as an expert technical resource to development staff throughout development and implementation

Senior Software Engineer

Clinical Assistant

• Support BlueCare Plus Clinical Review Managers at BCBST
• Serve as a key point of contact for providers and healthcare partners
• Answer provider questions
• Load authorization faxes
• Enter authorization requests received by phone
• Direct providers through the peer-to-peer review process
• Provide timely, accurate support through phone interactions and administrative coordination
• Deliver compassionate, member-centered support and respond to inquiries with empathy
• Screen incoming calls, faxes, and other digital requests for Utilization Management and/or Case Management
• Direct requests to the appropriate area and refer cases to Case Management and/or Transition of Care
• Receive, investigate, and resolve customer inquiries and claims
• Maintain departmental goals and perform assigned projects, reviews, and reports
• Load complete organization determination/notification for services according to internal policy
• Document and enter data into the appropriate system using departmental guidelines
• Interact with members, hospital staff, and provider staff regarding Utilization Management decisions and organization determination status
• Request additional or clarifying information and provide direction as necessary
• Search for and enter appropriate diagnosis and/or procedure codes during notification/prior authorization processes
• Work overtime as required

• Partner with members and families to identify supports and direct services for health, employment, and independent or community living goals
• Collaborate with clinical and social support colleagues to meet members’ physical, behavioral health, and long-term service needs
• Conduct thorough, objective face-to-face visits and assess members’ physical, behavioral, functional, psychosocial, financial, employment, and independent-living needs
• Use criteria to authorize appropriate home- and community-based services
• Confirm authorized services are provided and members’ needs are being met
• Travel to members’ homes for visits
• Manage requests and demands from internal and external stakeholders

Analyst

• Receive, triage, and distribute work from hardcopy mail, fax, GM mailboxes, Imaging, and Quality Improvement Organization-fast appeals calls
• Document the substance of appeals, grievances, and complaints in applicable systems according to timeliness requirements
• Utilize multiple systems to document appeals, grievances, and complaints
• Reroute correspondence to the appropriate person or area
• Follow up with members and providers regarding additional information, including medical records and Appointment of Representative Forms
• Document Facets inquiries, claims, utilization management, case management notes, and member benefits
• Mail and fax departmental outgoing correspondence according to CMS notification requirements
• Maintain knowledge of CMS regulations and guidelines affecting the appeal, grievance, and complaint process
• Ensure all work is accurately distributed each day

Appeals & Grievance Intake Analyst

Associate

• Imaging documents and monitoring scheduling of deliverables
• Utilizing information to improve services, anticipate and prevent problems, or suggest improvements
• Processing assigned work according to department procedures and expectations
• Interpreting transmittals and documents for group accounts
• Implementing appropriate filing and documentation procedures
• Maintaining all physical and electronic files in current and accurate condition
• Performing routine support and addressing administrative needs to meet membership and benefits services goals and case load expectations

Document Support Associate

General

• Support members’ physical, behavioral, and social health and well-being
• Assist members in finding and maintaining competitive, integrated employment
• Navigate challenging relationships to ensure members receive necessary services
• Perform intake, enrollment, and ongoing assessments
• Develop and maintain Person-Centered Plans
• Monitor and maintain overall service provision
• Partner with members and families to identify supports and direct services for health, employment, and independent or community living goals
• Collaborate with clinical and social support colleagues to meet members’ physical, behavioral health, and long-term service needs
• Conduct thorough, objective face-to-face visits and assess members’ physical, behavioral, functional, psychosocial, financial, employment, and independent-living needs
• Apply criteria to authorize appropriate home- and community-based services
• Confirm authorized services are provided and members’ needs are met
• Work an 8:00 a.m.–5:00 p.m. schedule with no on-call responsibility
• Travel to members’ homes in the Greene, Hamblen, and Jefferson County area

ECF Choices Support Coordinator

Artificial Intelligence

• Own operational oversight, quality standards, and escalation management for AI-enabled member service processes
• Lead complex issue triage, root cause analysis, and corrective action planning
• Define and maintain operational validation standards, sampling approaches, and quality measures
• Lead requirements definition, prioritization, and validation for enhancements and releases
• Drive user acceptance testing, operational readiness reviews, and post-release validation
• Define, monitor, and communicate key performance indicators and operational insights to leadership
• Serve as the primary operational liaison across Operations, Quality, IT, Analytics, and vendor partners
• Mentor analysts and establish repeatable standards, documentation practices, and best practices
• Translate AI strategy into dependable, compliant performance for member-facing virtual assistants
• Convert performance insights into prioritized cross-team actions that improve the virtual assistant while protecting reliability and compliance

Senior Operations AI Analyst

• 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

Member Support Coordinator

Software Engineer

• Formulate and define system scope and objectives through research and fact-finding
• Design, develop, modify, or integrate complex information systems
• Devise or modify application systems and procedures to optimize capacity, operating time, response time, and desired results
• Design, code, test, debug, and document programs, subroutines, and scripts
• Serve as project lead, business systems analyst, or technical lead for small to medium efforts, or manage phases of medium to large efforts
• Maintain technical skills in software languages, databases, platforms, operating systems, utilities, and networks
• Respond to system failures and performance events to reduce downtime and prevent recurrence
• Provide guidance and training to less-experienced analysts/programmers
• Support and enhance enterprise applications for Internal Audit, Compliance, Finance, Human Resources, Legal, and other Corporate Services partners
• Perform application development, modernization, integration, automation, and production support across primarily .NET-based applications
• Troubleshoot production issues and support application and server environments
• Develop APIs and integrations
• Optimize large-scale SQL data processes
• Partner with business stakeholders to deliver technology solutions supporting regulatory and operational needs
• Contribute to front-end enhancements, AI-driven workflow capabilities, and onboarding new business areas onto enterprise platforms

• Support a broad portfolio of critical provider-facing applications and services
• Develop, enhance, maintain, and support solutions for provider data management and operational processes
• Work across modern .NET Core applications, web services, APIs, batch processing solutions, and legacy platforms undergoing modernization
• Deliver new functionality
• Support production environments
• Troubleshoot complex integrations
• Help guide the future direction of the application portfolio
• Formulate and define system scope and objectives through research and fact-finding
• Design, develop, modify, or integrate complex information systems
• Devise or modify application systems and procedures to optimize capacity, operating time, response time, and desired results
• Design, code, test, debug, and document programs, subroutines, and scripts
• Serve as project lead, business systems analyst, or technical lead for small to medium efforts, or manage phases of medium to large efforts
• Maintain technical skills for software languages, databases, platforms, operating systems, utilities, and networks
• Respond to system failures and performance events to reduce downtime and prevent recurrence
• Provide guidance and training to less-experienced analysts/programmers