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Member Support Coordinator
BlueCross BlueShield of Tennessee. Serve as a key point of contact for individuals seeking information about the CHOICES program .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting screenings and managing referrals within the CHOICES program, while effectively communicating with members and external partners. Proficient in clinical assessment and problem resolution, ensuring timely service delivery and adherence to regulatory requirements.
Highest-signal resume keywords
Masters In Social Work (LCSW, LMSW, LAPSW)Registered Nurse (RN)Licensed Practical Nurse (LPN)Clinical ExperienceMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CHOICES ScreeningReferral ManagementClinical AssessmentService Delivery CoordinationDocumentation ReviewEligibility AssessmentDischarge PlanningPopulation Health CoordinationData AnalysisLTSS Options Education
Soft Skills
Time ManagementOral CommunicationWritten CommunicationInterpersonal SkillsOrganizational SkillsAnalytical SkillsAdaptability
Tools & Technologies
TennCare PAETennCare LTSS OperationsMaximus Tracking System
Certifications & Qualifications
LCSWLMSWLAPSWRN LicenseLPN License
Industry Keywords
LTSSD-SNP CoordinationNursing Facility DiversionDisenrollmentClinical ReviewEnrollment ProcessService DeliveryExternal Partnerships
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Fully remote role
- Employee position