BlueCross BlueShield of Tennessee

IT Support

• Provide overall direction, guidance, and definition of the EA to support the corporate business strategies.
• Leading in the implementation of EA strategies and best practices to support business objectives, while focusing on business process design, solutions, information gathering and technology utilization.
• Providing guidance to enterprise architects on defining technical service capabilities, design attributes, draft enterprise profiles and segment architecture; controlling risks and solving complex issues related to EA.
• Maintaining relationships with stakeholders, addresses stakeholder requirements and providing clients consultations to shape the future success of EA.
• Providing EA support by directing teams in baseline, target and roadmap development, transition planning, system and security management and segment architecture.
• Build and maintain architecture portfolio translating business strategies into IT investments.

Enterprise Architect II

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

Senior Operations AI Analyst

Care Coordinator

• Partnering with members and families to identify needed supports and direct services to meet personal goals for good health, employment and independent or community living
• Collaborates with a team of clinical and social support colleagues to meet the physical, behavioral health and long term service needs of each member
• Conduct thorough and objective face-to-face visits with and assess each members situation to determine current status and needs, including physical, behavioral, functional, psycho-social, financial, and employment and independent living expectations
• Utilizing criteria for authorizing appropriate home and community based services and confirm those services are being provided and that members needs are being met

Engineer

• Engineering and implementation of security technology solutions centric to Identity and Access Management security.
• Participating and/or assisting other team members in a rotating on-call schedule to promptly resolve high-priority issues that surface outside of normal business hours.
• Implementation, integration, configuration, and monitoring of Identity and Access Management solutions to ensure system health and proper SSO, MFA, provisioning/deprovisioning, and reduction of system related errors while ensuring compliance with corporate security standards and policies.
• Provides input into Access Control design and implementation, Application Credentials, ABAC (Attribute-Based Access Control) and RBAC (Role Based Access Control) roles, User Access Policy Management, Privileged Access Management, User Entitlements, Workflow, and Rule centralization while ensuring documentation is kept accurate with environment changes.
• Scripting, automation, and orchestration to drive efficiencies within Identity and Access Management.
• Partnering with security and risk teams to implement and maintain security policies and configurations in accordance with corporate requirements and guidelines.
• Assist in development/management of the password vault solution while ensuring accounts are properly identified and setup in the centralized repository, actual application/system, and IAM solution with appropriate ownership across all three application/systems.

Senior Identity & Access Management Engineer

Research Analyst

• Perform quality and/or compliance audits
• Coordinate Process Improvement based upon audit results
• Provide education and guidance on development of measures
• Consult for quality and compliance audits
• Analyze results for trends and identify non-compliance areas

Clinical Quality Research Analyst

Manager

• Manage members with newly diagnosed oncology conditions and Type 1 Diabetes
• Ensure timely and effective interventions and comprehensive health education
• Coordinate multidisciplinary resources and referrals
• Provide consistent follow-up to support optimal outcomes
• Oversee complex cases to ensure effective implementation of interventions and utilization of benefits

Digital Case Manager

Pharmacist

• Reviewing, updating, maintaining and monitoring pharmacy information disseminated to external and internal customers (as necessary).
• Conducting outbound educational telephone calls regarding medication adherence to members, prescribers and pharmacists as directed.
• Motivating members to become compliant by refilling their prescriptions and/or coordinating necessary communication or scheduling with providers and pharmacies.
• Handling customer service inquiries and problems via the telephone.

Outreach Pharmacy Specialist

Software Engineer

• Formulates and defines system scope and objectives through research and fact-finding to design, develop, modify, or integrate information systems
• Devises or modifies application systems and procedures to optimize functional requirements including capacity, operating time, response time, and form of desired results.
• Designs, codes, tests, debugs, and documents programs, subroutines, and scripts.
• Maintains technical skill set for software languages, databases, platforms, operating systems, utilities and networks needed to support work assignments.
• Responds to system failures and performance events by taking appropriate measures to reduce system downtime and eliminate recurrence of problems.
• May conduct presentations to provide end users with knowledge to maximize their use of developed systems.

Applications Developer

Consultant

• Support and sell BCBST Individual and Medicare group health products to groups, individuals and/or their broker/agent.
• Serve as primary resource contact and liaison for the broker/agent on Government individual products.
• Provide ongoing education to the broker/agent assigned and distribute materials.
• Develop and implement quarterly training and annual credentialing for all Medicare Advantage agents.
• Coordinate agent contracting documents from both agencies and individual agents.
• Maintain a working knowledge of CMS regulations, COBRA, HIPAA, etc. and other issues affecting groups, Individual and Government products.
• Train broker/agent on lead and enrollment systems.
• Some travel is required.

Agent Relations Consultant

• Support Medicare and D-SNP coverage review activities
• Enter authorizations and test claims into the pharmacy benefit system
• Handle incoming and outgoing calls from providers and members
• Monitor and answer emails and inquiries regarding pharmacy reviews
• Review daily pharmacy reports for claims processing
• Assist with departmental audits and quality improvement activities

Clinical Pharmacy Specialist – 2

• Directing and managing the delivery of large or complex application development projects
• Defining strategies and client needs focused on technology development
• Maintaining relationships with clients; communicating with IT and business management
• Monitoring prompt response and support for technical issues
• Ensuring high standards and quality of technical work
• Directing reviews of tools and technologies for improving performance and reducing costs
• Directing, motivating, developing and managing the performance of the management team and key staff

Director, Business Engineering

• Apply your knowledge of Behavioral Health and Withdrawal Management diagnoses.
• Navigate the continuum of care and levels of care for Behavioral Health and Withdrawal Management.
• Present cases confidently and effectively during clinical rounds.
• Work independently with minimal supervision.
• Excel in a fast-paced, dynamic environment.

Behavioral Health Clinical Review Manager

General

• Serve as a critical operational leader—coaching and developing a team of care managers
• Overseeing daily workflows, and ensuring quality, productivity, and adherence to evidence-based practices
• Onboarding and supporting a rapidly growing team, providing real-time guidance, performance management, and issue resolution
• Monitoring productivity and performance based on departmental goals; identifying areas for quality improvement and ensuring updated processes are implemented
• Supervises, hires, motivates, and evaluates staff to assure effectiveness of programs and appropriate professional evaluation of clinical services
• Coordinates clinical interface with internal/external clients to ensure delivery of quality services
• Facilitates the implementation of programs, policies, and procedures related to clinical management programs
• Performing quality audits and review audit findings, providing feedback and training to staff as needed regarding clinical or technical information

Supervisor, Case Management

• Support data modeling tasks on multiple database technologies
• Design, deliver, and govern scalable data models across operational and analytical environments
• Translate business requirements into optimized structures, ensuring data quality and standards
• Establish, document, and enforce data standards, naming conventions, and modeling best practices
• Collaborate with data analysts, DBAs, architects, and engineers to align models with business needs
• Optimize data models for performance, scalability, and security

Data Modeler

Technical Project Manager

• Independently manages enterprise projects
• Updates and maintains current project information within the established project management tool
• Manages scope and the execution of change management processes
• Ensures procurement of hardware, software and human resources as needed for the project
• Tracks and reports risks and issues
• Builds contingency plans