Member Support Coordinator

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Act as a primary contact for individuals seeking information regarding the CHOICES program.

• Assist members and their family representatives in understanding available services and navigating the screening and referral process.

• Conduct CHOICES screenings via telephone.

• Manage incoming referrals and communicate with members and authorized representatives by phone.

• Collect information and evaluate potential program eligibility.

• Provide education about available Long-Term Services and Supports (LTSS) options.

• Ensure the screening process progresses in a timely manner.

• Collaborate with BlueCare internal departments and external partners to facilitate enrollments, admissions, transitions, nursing facility diversion, discharge planning, Population Health coordination, D-SNP coordination, and address service delivery or provider concerns.

• Investigate concerns and requests utilizing clinical knowledge and expertise to assist in problem-solving.

• Obtain, review, and evaluate reports including 834, ERC services, non-members with authorizations, expiring authorizations, daily inpatient census, and MIPPA reports.

• Distribute clinical review outcomes and collaboration requests to relevant internal departments or Dual Special Needs Programs.

• Assess LTSS requests and required documents while managing referrals, screenings, medical and educational records, enrollment, transitions, discharge planning, coordination, reassessments, cost of care, admissions/discharges, evaluations, authorizations, and disenrollments.

• Submit finalized requests and supporting documents to TennCare PAE and tracking system, TennCare LTSS Operations, or Maximus.

• Monitor dispositions and communicate them to the appropriate personnel.

⛳️ Requirements

• Must be a resident of the State of Tennessee.

• Must possess a Master's in Social Work (LCSW, LMSW, or LAPSW) OR Registered Nurse (RN) OR Licensed Practical Nurse (LPN) license.

• A minimum of 3 years of clinical experience is required.

• Proficient in Microsoft Office Suite (Outlook, Word, Excel, and PowerPoint).

• Excellent time management abilities.

• Outstanding verbal and written communication skills.

• Strong interpersonal and organizational capabilities.

• Strong analytical skills.

• Ability to adapt in a fast-paced and evolving environment.

• Must be capable of maintaining professional relationships with vendors and other external partners.

• Ability to work independently on multiple tasks with critical deadlines and minimal supervision, as well as collaboratively as part of a team.

🏝️ Benefits

• Fully remote position.

• Employee role.