BlueCross BlueShield of Tennessee

Consultant

• Providing senior level consulting services to internal business groups on process improvement projects designed to improve their business results.
• Analyzing, defining and documenting clients requirements, and revising existing systems logic challenges, as necessary.
• Monitoring client experiences and feedback on the use of business applications; Enhancing system productivity, as needed.
• Participating in identifying, evaluating, and developing systems that are cost effective and meet business requirements.

Business System Consultant

Director

• Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements
• Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate
• Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
• Leads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals

Director, Clinical Pharmacy

• Collecting data and analyzing workforce needs, systems, trends and metrics
• Providing reports and consultation to help management develop strategies and make business management decisions
• Interpreting data and creating dashboards for management to identify key performance indicators and monitor productivity
• Helping organization understand the relationship between the workforce and business processes, issues, needs and systems

Workforce Analytics Consultant, Employee Listening

Program Manager

• Supports BlueCare Tennessee’s member experience and compliance strategy
• Tracks progress according to program schedules and develops solutions to problems
• Provides reporting to management
• Assists in the preparations of proposals, plans and specifications of projects or programs
• Develops the project scope documents, project timetables and other related documents
• Coordinates and monitors the scheduling and status of programs

Program Management Coordinator

Manager

• Serve TennCare members with Intellectual and Developmental Disabilities enrolled in a 1915(c) Waiver program.
• Coordinate care across multiple partners and benefit programs.
• Manage complex situations where additional support is needed.
• Oversee challenging cases to ensure effective interventions and appropriate service utilization.

Case Manager

• Initiate referrals and support care coordination workflows by gathering required clinical information and confirming benefit completeness under established UM procedures.
• Perform structured clinical reviews using preset criteria and templates, escalating any findings requiring RN/Medical Director interpretation.
• Consult with supervising RN or Medical Director when requests involve clinical questions, exceptions, or scenarios requiring higher level clinical judgment.
• Assist nonclinical staff by clarifying clinical documentation, interpreting request elements within LPN practice parameters.
• Apply approved medical appropriateness criteria and contractual eligibility information to support intake validation and preparation of clinical review materials.
• Document all review activities in required UM systems with accuracy, completeness, and adherence to regulatory documentation standards.
• Communicate with providers, members, and internal teams regarding missing documentation, process requirements, and case status.
• Participate in quality improvement, compliance activities, and competency requirements tied to UM program standards.

Clinical Review Manager – LPN

Database Administrator

• Utilizing logical models to ensure efficient and reliable database performance.
• Designing and developing logical and physical layers for various databases.
• Leading in handling data testing, reporting, back-ups and restorations.
• Managing and maintaining data in all production and non-production databases and replication servers.
• Providing technical assistance and mentoring staff on developing conceptual and logical database designs and physical databases.

Senior Database Administrator

Data Scientist

• Lead in applying Machine Learning algorithms to develop predictive models for business applications.
• Extract meaningful insight from semi-structured and unstructured data sources, including natural language processing (NLP)
• Lead in designing, extracting, normalizing, analyzing, reviewing and automating analysis utilizing our Data Warehouse, extracts and data exploration tools; coordinate with appropriate subject matter experts on data source requirements.
• Lead in designing & developing data visualizations for data storytelling.
• Design and develop ad-hoc analysis based on business requirement needs.
• Actively participate in the completion of department initiatives to support the development of a best-in-class Data Science function.
• Prototype data science products.
• Complete work without direct day-to-day supervision, and help guide junior team members when they need assistance.
• Stay up-to-date with the latest advancements in data science and related fields, and share with team members to drive innovation.
• Build strong relationships to understand the business and connect data scientists to business use cases.

Senior Data Scientist

• 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.

FEP Case Manager

Platform Engineer

• Ensure the performance, security and durability of platforms
• Maintain the infrastructure and services required to support them
• Build the infrastructure and services required to support platforms
• Include monitoring, and management of server infrastructure
• Maintain and improve build and release management systems
• Implement internal APIs and tools to support backend services
• Perform customization and configuration changes on platforms

• Lead the enterprise Business and Cyber Resilience program, shifting from legacy DR/BC approaches to cyber-resilient recovery models.
• Direct the end-to-end resilience lifecycle, including cyber-informed Business Impact Analysis (BIA), risk assessment, recovery strategy development, and testing.
• Manage the existing BIA process with business units to identify critical processes, system dependencies, and recovery objectives (RTO/RPO).
• Maintain and evolve cyber business continuity and disaster recovery plans across on-premises, cloud, and hybrid environments.
• Partner with business owners, infrastructure, application, and cybersecurity teams to assess recovery readiness, data protection, and secure restoration capabilities.
• Develop and execute strategies to enhance business and cyber resilience, including recoverability from ransomware and other destructive cyber events.
• Establish and enforce resilience-related policies, standards, and best practices aligned with governance and regulatory expectations.
• Promote enterprise awareness of how cyber risk impacts business operations, continuity, and recovery outcomes.
• Plan and lead cyber resilience exercises, including disaster recovery tests and cyber disruption tabletop scenarios, to drive continuous improvement.
• Participate in an on-call rotation to support coordinated recovery and business resumption activities during major disruptions.

Manager, Cyber and Business Resilience

Systems Engineer

• Providing recommendations for addressing and resolving business issues, for a specific business group.
• Directing business process improvement projects for internal business groups, aiming to improve business results.
• Identifying and documenting all system constraints, implications and consequences of various proposed system changes.
• Provides direction in assessing impact of change, defining business rules, and implementing solutions across a broad range of functional boundaries.
• Competent to work at the highest technical level of most phases of systems analysis while considering the business implications of the application of technology to the current and future business environment.
• Leads requirements analysis and verification, ensuring that requirement statements are complete, consistent, traceable, feasible, and verifiable
• Collaborates with the technical and project teams to ensure that the results of the project fully satisfy the needs embodied in the requirements.
• Proactively identifies opportunities for improvement in requirements gathering, documentation, and translation.
• 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.

Business Systems Analyst

Designer

• Design and deliver conversational experiences for AI assistants across chat, web, mobile, and voice channels.
• Develop dialog flows, conversation maps, and content models for natural, context-aware interactions.
• Write and refine prompts, responses, and error-handling language aligned with brand tone and clarity.
• Collaborate with cross-functional teams (Product, Engineering, SMEs) to translate business needs into user-centered journeys.
• Partner with NLU/NLP teams to define and optimize intents, entities, and fallback strategies.
• Conduct usability reviews and analyze interaction data to identify friction points and improve performance.
• Ensure compliance with governance, privacy, accessibility, and brand standards.
• Document reusable patterns, style guidelines, and best practices for consistency and scalability.

Senior Conversational Designer

Customer Support

• Provide vital support to Medicare-eligible members by assisting them with finding providers, resolving billing issues, obtaining prescriptions, and more
• Receiving, investigating and resolving all customer inquiries timely and accurately
• Handling customer service inquiries and problems via the telephone
• Ensuring all customer communication is clearly documented
• Educating caller to ensure resolution is achieved on first contact
• Must be able to pass required testing
• Participation and attendance are mandatory
• Work overtime as required

Customer Service Trainee

Full-stack Engineer

• Formulates and defines system scope and objectives through research and fact-finding to design, develop, modify, or integrate complex 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.
• Develops and implements program/system test plans.
• Devises data verification methods and standard system procedures.
• Responds to system failures and performance events by taking appropriate measures to reduce system downtime and eliminate recurrence of problems.
• May conduct research on software and hardware products to justify recommendations and support management in budgeting and purchasing efforts.
• Acts as expert technical resource to development staff in all phases of the development and implementation process.