BlueCross BlueShield of Tennessee · 15 hours ago
Member Support Coordinator
Nashville, TN
Full-time
Onsite
Mid Level
3+ years expBlueCross BlueShield of Tennessee is seeking a Member Support Coordinator to join their LTSS Clinical Support Team. In this role, you will support the CHOICES program by screening applicants and managing documentation for TennCare systems while ensuring compliance with established requirements.
Health CareMedical
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
Qualification
Required
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
Preferred
Experience with PERLSS, Agent Workspace, Maximus, Care Advance, CHOICES and TennCare Connect
Company
BlueCross BlueShield of Tennessee
As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years.
5001-10000 employees
H1B Sponsorship
BlueCross BlueShield of Tennessee has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (26)
2024 (38)
2023 (36)
2022 (44)
2021 (56)
2020 (58)
Funding
Current Stage
Late StageLeadership Team
Casey Dungan
President and Chief Executive Officer - BlueCare
Melissa Scissom
COO, Cover Tenn
Recent News
2026-01-06
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