Member Support Coordinator

Remote

USA, TN, Chattanooga, Remote

Full time

R-51322

Our Long-Term Services and Supports (LTSS) Clinical Support team is looking for a new Member Support Coordinator!

We are seeking a compassionate, organized, and member-focused Member Support Coordinator who is passionate about helping Tenn Care members access the long-term services and supports they need to remain safely and independently in their homes and communities. In this role, you will serve as a key point of contact for individuals seeking information about the CHOICES program, helping members and their family representatives understand available services and navigate the screening and referral process.

As part of our LTSS Clinical Support team, you will conduct CHOICES screenings telephonically , manage incoming referrals, and engage directly with members and their authorized representatives by phone. You will play an essential role in gathering information, assessing potential program eligibility, educating individuals about available LTSS options, and ensuring timely progression through the screening process. This position requires strong communication skills, attention to detail, and the ability to build trust with individuals who may be facing significant health, functional, or caregiving challenges.

To be successful in this role, you will need excellent customer service and organizational skills, the ability to manage multiple priorities in a fast-paced environment, and a commitment to delivering a positive member experience. This position is ideal for someone who enjoys helping others, thrives on meaningful member interactions, and is motivated by improving access to quality long-term services and supports for Tenn Care members across Tennessee.

Note:

• Must live in the State of Tennessee
• Fully remote role
• Must hold a Masters in Social Work (LCSW, LMSW, or LAPSW) OR Registered Nurse (RN) OR Licensed Practical Nurse (LPN) license.

Job Responsibilities

• Provides an interface for Blue Care internal departments, (UM, Appeals, Population Health, Blue Care plus, etc) and external partners (other MCOs, Division of Tenn Care, providers, D-SNPs, Maximus, DCS, DIDD) to provide assistance with enrollments, admissions and transitions, NF diversion, discharge planning, Population Health coordination, D-SNP coordination and assisting care coordinators in resolving concerns about service delivery or providers. MSC will research the concern/request in detail utilizing clinical knowledge/expertise and assist in resolving problems, issues, or complying with request.
• Obtain, review and assess reports including, but not limited to 834 for skilled services, ERC services, Non-members with Authorizations, Expiring Authorizations, Daily Inpatient Census and MIPPA Report. The results of clinical review and/or request for collaboration will then be disseminated to appropriate internal departments or Dual Special Needs Programs.
• Utilize clinical knowledge and expertise to review Long Term Services and Support (LTSS) requests and required documents, then manage requests to include referrals/screenings, obtaining medical and educational records, enrollment, transitions, discharge planning, Population Health coordination, Dual Special Needs Program (D-SNP) coordination, monitoring for Katie Beckett enrollments, annual reassessments and cost of care, nursing facility and hospital admissions/discharges, Complex Respiratory Care evaluations and ERC authorizations, and disenrollments from LTSS.
• The Member Support Coordinator is responsible for submitting appropriate completed requests and supporting documents to Tenn Care PAE and tracking system, Tenn Care LTSS Operations or Maximus (PASRR, level of care) and monitors for disposition that is then communicated to…