BlueCross BlueShield of Tennessee

Manager

• Conduct onsite visits to local Acute Inpatient Psychiatric facility in the Murfreesboro area
• Participate in treatment team meetings, sharing insights on member cases
• Assist members in finding appropriate care or resources post-discharge
• Collaborate with providers and internal teams to meet member needs and resolve challenges
• Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions

Behavioral Health Case Manager

• Manage prior authorization for home health and DME services
• Oversee home health case managers supporting medically complex members
• Ensure timely medically necessary in-home services
• Participate in developing strategies, policies, and procedures related to clinical management programs
• Manage a team(s) of clinical staff to assure effectiveness

Manager – Medical Management

Consultant

• Build relationships with provider offices to coordinate and execute wellness events
• Engage multiple partners (providers, vendors, Member Outreach, Transportation)
• Drive gap‑closure success through event planning, member attendance efforts, and follow‑up reporting
• Monitoring health education programs trending and analysis of findings and making improvements.
• Implementing outreach programs to members and providers to facilitate an increase in the number of preventative health services.
• Supports the planning and execution of community outreach initiatives which focus on improving the Stars quality scores, improving the overall member experience and improving member health outcomes.
• Ensuring quality and performance standards as defined by CMS, BCBSA, BCBST and all accrediting bodies.
• Travel about 50% of the time across Tennessee (with flexibility to choose regions)

Member Experience Program Consultant

Financial Planning and Analysis

• Working with internal staff and external customers and suppliers to clarify differences and reconcile conflicts
• Reviews quality errors and provides feedback; performs supplemental audits as needed
• Serving as project lead for process improvement initiatives
• Paying bills and invoices in accordance with established methods and procedures
• Making deposits for incoming receipts

Financial Transactions Analyst

Medical Director

• Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines. • Analyze, evaluate and apply clinical metrics that produce actionable information in support of medical management and quality improvement initiatives. • Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews. • Lead and serve on various committees in order to accomplish medical utilization, cost and quality objectives of BCBST. • Willingness to travel within the State of Tennessee and nationally.

Medical Director – Consultant

• Assess member needs and create individualized care plans.
• Educate and support members through some of life’s most complex transitions.
• Coordinate care with OB/GYNs, PCPs, and behavioral health specialists
• Monitor progress, adjust plans, and advocate for access and adherence.
• Supporting utilization management functions for more complex and non-routine cases as needed.
• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
• Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation.
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support.

Women's Healthcare Case Manager

Analyst

• Assist in administration of member rights pursuant to enterprise-wide policies and procedures
• Perform Privacy Office tasks, projects, and activities in furtherance of the Privacy Office and enterprise-wide privacy program, including maintaining and implementing enterprise policies and procedures
• Implementing education and training for employees and contractors
• Support response to potential unauthorized uses and disclosures of member information
• Assist in response of the Privacy Office to privacy-related issues and concerns received by the Privacy Office

Associate Privacy Analyst

Systems Engineer

• Act as a primary contact for the configuration, development, and support of multiple financial systems across the controller and treasury divisions.
• Develop high-level business requirements and translate them into functional specifications for the IT organization and manage changes to such specifications.
• May serve one or more project team roles, such as project lead, business systems analyst lead, or technical lead, for small to medium efforts or manage phases of medium to large efforts.
• Proactively identifies opportunities for improvement in requirements gathering, documentation, and translation

Senior Financial Systems Analyst

• Assess members’ current status
• Facilitate coordination of long-term services and supports
• Collaborate with members, caregivers, conservators, and providers to develop individual plans of care
• Monitor progress for members with multiple levels of acuity
• Perform telephonic contacts and in-person home visits with members at least monthly
• Support utilization management functions for complex cases
• Serve as a liaison between members, providers and internal/external customers
• Oversee highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits