BlueCross BlueShield of Tennessee

Manager

• Evaluate and enhance the efficiency, effectiveness, and quality of work flow, and lead performance improvement efforts to identify opportunities for improvement and to implement best practice solutions.
• Manage supervisory level personnel and care coordination staff, as well as hiring and ongoing training of the care coordination team.
• Interact, facilitate, and establish partnerships and collaborations with internal and external stakeholder.
• Develop and maintain reporting mechanisms to allow for tracking, trending, and monitoring of initiatives and outcomes.
• Facilitate gathering, analyze, and present data to comply with reporting requirements.
• Ensure compliance with federal, state, and agency policies, procedures, and standards through documentation review, clinical outcomes analysis, and staff education.

Care Coordinator Manager

Full-stack Engineer

• Management of Salesforce orgs
• Application of DevSecOps formal processes and tools in a Salesforce-based environment
• 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
• Acts as expert technical resource to development staff in all phases of the development and implementation process

Senior Software Engineer – Salesforce

• Provide both clinical and operational support through data collection, care coordination activities, provider and vendor communication, timely report distribution, and day‑to‑day assistance to team experts and leadership.
• Support member outreach, referrals, appointment scheduling, and accurate documentation to ensure efficient, compliant care coordination.
• Initiate referrals and support care coordination workflows by gathering clinical, functional, and social information needed for RN led case assessment and service planning, following established case management procedures.
• Perform structured case management support activities (e.g., follow up calls, resource coordination, appointment scheduling, and preparation of case summaries) using predefined tools and templates, escalating any findings that require RN/Medical Director interpretation.
• Communicate with members, providers, caregivers, and internal teams regarding required documentation, service logistics, resource connections, and case status, using approved scripts and escalation pathways.
• Participate in quality improvement, compliance activities, and competency requirements tied to case management program standards.

Case Manager, LPN

Technical Project Manager

• Manages enterprise projects with little assistance.
• Updates and maintains current project information within the established project management tool.
• Manages scope and the execution of change management processes.
• Ensures the procurement of hardware, software and human resources as needed for the project.
• Manages project costs, and works with project owners, stakeholders, and delivery team to manage project quality.
• Tracks and reports risks and issues.
• Proactively evaluates project activities.
• Builds contingency plans.
• Executes corrective actions when necessary.
• Implements risk response plans to manage risk.

Project Manager II

• Works with internal and external stakeholders to deliver effective analytic solutions that meet business needs
• Assesses the scope and resources required for a wide variety of analytic requests, data modifications and enhancements and special projects
• Identifies necessary resource requirements and tracks assignments to ensure timely completion
• Escalates issues appropriately and works with senior management for resolution
• Monitors and communicates key performance metrics and operational challenges.

HEDIS Technical Manager

Project Manager

• Coordinate and track recurring compliance and financial reporting deliverables
• Prepare and maintain written summaries, schedules, and supporting documentation for audits and regulatory submissions
• Facilitate working sessions and review meetings, including agendas, materials, and action tracking
• Maintain reporting databases, control documentation, and departmental policies and procedures
• Ensure reports and compliance artifacts are accurate, complete, and delivered within prescribed timelines
• Collaborate within a high visibility role across multiple departments and levels of senior leadership throughout the company

Project Coordinator

Product Manager

• Working closely with stakeholders to understand business and advance solutions
• Supporting Customer Support, Sales Enablement, and Product Marketing in digital strategies
• Collaborating with cross-functional teams to develop and propose digital strategy
• Overseeing a backlog that aligns with available engineering capacity
• Leading Agile ceremonies and collaboration meetings with technology teams
• Coordinating with cross-functional teams to support product and program optimizations

Associate Digital Product Manager – Member AI

Artificial Intelligence

• Assist with simple coding tasks, model configuration steps, or data preparation activities under direct supervision.
• Perform hands-on learning exercises to build familiarity with Python, AI tools, and cloud environments (e.g., GCP Vertex AI).
• Complete assigned upskilling tasks related to machine learning, Generative AI, Python, or relevant frameworks.
• Support basic agent-building activities, such as configuring prompts, testing agent behaviors, or validating simple workflows.
• Participate in brainstorms and innovation sessions to explore new ideas, tools, and AI capabilities.
• Clearly document work, track progress on assigned tasks, and communicate updates, challenges, and findings effectively to team members.

AI Workflow Engineer

Analyst

• Reviewing and processing appeals and grievances submitted by Members and Providers
• Documenting and investigating the substance of the appeal, grievance, or complaint
• Notifying involved parties of the outcome of a review
• Providing excellent customer services to members, providers and CMS
• Maintaining knowledge of and adhering to CMS regulations and guidelines

Senior Appeals and Grievance Analyst

• Support critical BlueCard claims processing by maintaining and enhancing internal‑facing applications
• Help modernize legacy systems
• Design, code, test, debug, and document programs, subroutines, and scripts
• Formulate and define system scope and objectives through research and fact-finding
• Optimize functional requirements including capacity, operating time, response time, and form of desired results
• Respond to system failures and performance events

Software Engineer

• Support the analysis of complex enterprise system integrations
• Help develop flexible, scalable communication solutions using ASP.NET, Web APIs, and SQL
• Formulates and defines system scope and objectives through research and fact-finding
• Devises or modifies application systems and procedures to optimize functional requirements
• Designs, codes, tests, debugs, and documents programs, subroutines, and scripts
• May serve one or more project team roles
• 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

IT Support

• Manages the day-to-day operations of a team with a focus on the maintenance and development of systems and supervising system modifications.
• Assigns, monitors, and reviews progress and accuracy of work.
• Provides staff management oversight including hiring, promoting, or making recommendations for staff.
• Conducts performance reviews and assessments, manages performance, engages in skills assessment, and promotes professional development of staff.
• Ensures adherence to policies, plans, objectives, budgets and staffing allocations.
• Manages and tracks team-level project details and serves as the technical subject matter expert and provides leadership during periods of transition.

EIT Engineering Team Lead

QA Engineer

• Validate end‑to‑end functionality, integrations, data flows, and user experiences within Salesforce.
• Collaborate with cross-functional teams to execute comprehensive test plans and identify defects early in the development cycle.
• Create and execute test scripts for functional, automation and/or performance testing.
• Review technical design documents and develop E2E integration test scenarios.
• Identify and create test data, build, and execute services/API validation scripts.

SQA Analyst II

• 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 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.

Case Manager

• Auditing provider documentation and supporting HEDIS quality initiatives
• Analyzing clinical data to identify gaps and performance opportunities
• Partnering with provider offices to enhance Stars performance
• Ensuring compliance with regulatory and organizational standards
• Supporting provider outreach to strengthen quality measures across the network
• Presenting and communicating audit results to appropriate parties
• Schedule and perform routine facility, practitioner site, and medical record reviews
• Identifying and evaluating areas of exposure, potential problems and liabilities
• Analyze clinical data to improve individual provider compliance with education
• Providing required documents and consulting support for quality and compliance audits

Care Coordinator Manager

Senior Software Engineer – Salesforce

Case Manager, LPN

Project Manager II

HEDIS Technical Manager

Project Coordinator

Associate Digital Product Manager – Member AI

AI Workflow Engineer

Senior Appeals and Grievance Analyst

Software Engineer

Software Engineer

EIT Engineering Team Lead

SQA Analyst II

Case Manager

Clinical Quality Assurance Auditor