Member Support Coordinator - ECF Nashville, TN/en-US/External/job/Nashville-TN/Member-Support-Coordinator---ECF_R-13470-1/applyThe BlueCare CHOICES and ECF CHOICES programs offer person-centered care planning, service coordination, and support services for members receiving long-term care; home and community based services; and/or employment and housing services. The ancillary care/support coordinator works alongside HCBS, discharge, and institutional care coordinators to promote interdependent collaboration with the member, physician/primary care manager, family, and other members of the care coordination team. To accomplish this collaboration, the Member Support Coordinator is part of the care/support coordination team. These positions assist in ensuring quality support by performing activities as needed to support HCBS, discharge, transition of care from various institutional and community settings and collaborating directly with care/support coordinators. Positions are available at BlueCare offices located in Nashville, TN. Job Description: Job Duties & Responsibilities * Upon direct referral, conduct telephonic screenings with BlueCare members to determine if they may need and qualify for the CHOICES/ECF CHOICES program OR assist the person in completing the online ECF CHOICES self-screening tool. * Receive external incoming calls or email notifications from providers, DIDD, other MCOs or the Bureau of TennCare. MSC will research the concern in detail utilizing clinical knowledge/expertise and assist in resolving problems issues. Alert assigned care/support coordinator of issues and outcome. * Provide status updates to requesting entity on issue or concern. Document in system of record per protocol. * Provide assistance with community transitions, NF diversion; discharge planning, Population Health coordination, Dual SNP coordination and assisting care/support coordinators in resolving concerns about service delivery or providers.

• Detail clinical review, (to include, but not limited to medical records, PAE, interview tools, respiratory care documentation, MFP qualifications,) of all requests from Care/Support Coordination in order to determine if TennCare criteria are met prior to entry into TPAES. * Provide clinical feedback and training to care/support coordinators on accurate/appropriate documentation of TennCare requirements and updates for all TPAES submissions. * Assist Support Center in processing authorizations for non-medical services. * Obtain and review request for Enhanced Respiratory Care services including review of medical documentation related to respiratory care. This includes chronic ventilators, ventilator weaning, and tracheal suctioning. * Create and document authorization for chronic ventilator and/or frequent tracheal suctioning for NF. Notify NF of authorization. * In depth clinical review of all documentation related to respiratory care services at least every 30 days according to ERC policy/procedure and escalate to Transition of Care/Medical Director as appropriate for possible weaning authorization for each member. * Obtain monthly attestation from NF for ventilator licensed bed availability. Document in system of record. * Request, obtain and review medical records for Care Coordination process to support PAE and transition submissions. * Process faxed documents received, which includes but is not limited to, disenrollment, NF transfers, new referrals and medical records. * Interact with Onsite and Case Management areas to ensure smooth transfer of member information across the continuum of care. * Provides an interface for BlueCare internal departments, (UM, Appeals, Population Health, BlueCare plus, etc.) and the CHOICES and ECF CHOICES program. * Establish and maintain positive working relations with referral sources, community resources, and care providers. * Provides assistance with coordination of members needs across the continuum of care. * Develop and maintain relationships with staff from other health plans related to care coordination of program members. * Obtain, review and assess reports (834 for skilled services, Non-members with auths, expiring auths, inpatient census report). Disseminate results of clinical review to appropriate internal departments. * Maintain MFP Candidate ID report, Monthly MFP report. * Maintain DSNP ongoing report and quarterly report. * Other duties deemed necessary for efficient and effective unit operations. Job Qualifications Education * Masters in Social Work (LCSW, LMSW, or LAPSW) OR Registered nurse (RN) OR Licensed Practical Nurse (LPN);; with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act Experience * Minimum 3 years varied clinical experience required. * Minimum 2 years experience providing care coordination support to persons receiving long-term care and/or home and community based services and an additional year of work experience in managed and/or long-term care setting highly preferred. * Prefer 2 years continuous experience working with people who have intellectual and developmental disabilities * Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria preferred. Skills/Certifications * Exceptional skills of independence, organization, communication, problem-solving, professional interaction, and human relation skills, as well as analytical skills required. * Ability to work within specified timeframe requirements * Must be able to handle interruptions, set priorities and adapt to change
• Must be well organized and have experience in managing multiple assignments with critical deadlines * Excellent communications skills (both verbal and written) * Proficient knowledge of PC and Microsoft Office * Ability to maintain professional and courteous internal communication with various departments, in the exchange of information. Job Specific Requirements: Number of Openings Available: 1 Worker Type: Employee Worker Sub-Type: Regular Company: VSHP Volunteer State Health Plan, Inc BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to 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 membership in a historically under-represented group. 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. Tobacco-Free Hiring Statement To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products in any form in Tennessee and where state law permits. A tobacco-free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a tobacco/nicotine test. An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn. Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW. Posted TodayFull timeR-13470 About Us As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.