BlueCross BlueShield of Tennessee Care Coordinator in Johnson City, Tennessee

Effective 11/1/16: Employees who are required to drive his or her personal vehicle or a rental vehicle on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy; and maintaining an acceptable motor vehicle record (MVR).

*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

The Volunteer State Health Plan, Inc. (VSHP) CHOICES program offers person-centered care planning, service coordination, and support services for members receiving long-term care services such as home and community-based services (HCBS) and nursing facility placement. The care coordinator is responsible for promoting interdependent collaboration for member’s continuum of care with the member, physician/primary care manager, family, nursing facility and other members of the care coordination team. To accomplish this collaboration, the Care Coordinator is responsible for assessing the member’s potential for and interest in:

1. Transitioning from institutional facility care to home and community-based services care,

2. Nursing facility diversion, allowing member to remain in home with community-based services

3. Nursing facility placement for those enrollees not able to remain at home

The Care Coordinator is responsible for performing face-to-face assessments and the implementation, monitoring, and evaluation of available resources in an effort to promote quality, cost effective outcomes while meeting the individual’s health needs. The care coordinator assists the enrollee in the identification of appropriate providers and facilitates authorized services in an effort to improve or maintain the social, emotional, functional and physical health status of the member, as well as enhance the coping skills of the family or other caregiver. This position is field based and requires travel to conduct face-to-face assessments with members. Positions are available throughout the East and West Grand Regions of TN.

Job Description:

Job Duties & Responsibilities

Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.

The care coordinator will perform the following essential activities of care coordination:

  • Assessment – The care coordinator will collect in-depth information about a person’s situation and functioning to identify individual needs in order to identify members at risk with complex clinical and social issues and develop a comprehensive plan of care that will address those needs.
  • Planning – The care coordinator will involve the enrollee and other significant parties in the determination of specific objectives, goals, and actions as identified through the assessment process. The plan of care will be action oriented and time specific.
  • Implementation – The care coordinator will facilitate and execute specific interventions that will lead to accomplishing the goals established in the plan of care to ensure the member’s health, safety, and welfare, and as applicable, to delay or prevent the need for institutional placement.
  • Coordination – The care coordinator will organize, integrate, and modify the resources necessary to accomplish the goals established in the plan of care.
  • Monitoring – The care coordinator will gather sufficient information from all relevant sources in order to determine the effectiveness of the plan of care, including regular prescribed contacts with member and perform updates to the assessment and plan of care as needed.
  • Evaluation – At appropriate and repeated intervals, the care coordinator will determine the plan of care’s effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the plan of care in its entirety or in any of its component parts.

Care Coordination Functions

  • Conduct thorough and objective face-to-face assessments of the member to determine current status and needs, including physical, behavioral, functional, psychosocial, and financial, and health status expectation.
  • Assess clinical information for use in development of comprehensive individualized plans of care for members.
  • Identify members with the potential for high risk complications and coordinate the appropriate treatment in conjunction with the member and care coordination team.
  • Conduct a thorough and objective face-to-face assessment of members residing in an institutional setting to determine current status and needs, including whether the member has the potential for and interest in transitioning from institutional care to home and community-based care.
  • Coordinate with institutional facilities as necessary to facilitate access to physical health and/or behavioral health services needed by the member and to help ensure the proper management of the member’s acute and/or chronic physical health or behavioral health conditions.
  • Assess clinical information to develop an individualized transition plan, if appropriate, that will address all the services necessary to safely transition the member to the community, including, but not limited to, member needs related to housing, transportation, availability of caregivers, and other transition needs and supports.
  • Act as an advocate for an individual’s health care needs by identifying and communicating any barriers to a safe transition and strategies to overcome those barriers.
  • Act as an advocate for an individual’s health care needs by identifying and communicating opportunities for care intervention, including identifying and addressing gaps in care.
  • Utilize criteria for authorizing appropriate home and community based services, obtain authorization for those services, and confirm those services are being provided and that members’ needs are being met.
  • Monitor and ensure that provision of covered physical health, behavioral health, and/or home and community based services are provided as a cost-effective alternative.
  • Management of critical transitions, such as hospital discharge planning.
  • Develop and implement targeted strategies to improve health, functional, or quality of life outcomes, such as disease management or pharmacy management.
  • Serve as a point of contact for coordination of all physical health, behavioral health, home and community based services and nursing facility services.
  • Proactively educate members about the program, including opportunities for consumer direction of HCBS, and obtain necessary consents for participation.
  • Coordinate with the Fiscal Employer Agent (FEA) as needed.
  • Conduct, review, and revise, as necessary, member’s risk assessment and risk agreement.
  • Maintain appropriate and ongoing communications and collaborations with members, their authorized representatives, physicians and health team members, and payer representatives.
  • Provide assistance in resolving concerns about service delivery or providers.
  • Coordinate with member’s primary care provider, specialists, and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care.
  • Provide members with education about the ability to use an advance directive.
  • Compare member’s plan of care to establish pathways to determine variances and then intervene as indicated
  • Routinely assess and monitor member’s status, needs, and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments in their plan of care, providers and/or services to promote better outcomes.
  • Report quantifiable impact, quality of care, and/or quality of life improvements as measured against the care coordination goals
  • Establish working relations with referral sources, community resources, and care providers.
  • Conducts face-to-face visits in the member’s residence within the first twenty-four (24) hours of transition from a nursing facility and monthly visits thereafter for ninety (90) days

Job Qualifications

Education

  • Registered Nurse with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law; or master’s level Social Worker with active license in the state of Tennessee (LCSW, LMSW, or LAPSW).

Experience

  • Minimum of 5 years healthcare w/ 3 years clinical experience required.
  • Prefer 3 years experience providing care coordination to persons receiving long-term care and/or home and community based services and an additional 2 years work experience in managed and/or long-term care settings.

Skills/Certifications

  • Exceptional skills of independence, organization, communication, problem-solving, professional interaction, and human relation skills, as well as analytical skills required.
  • Ability to work within specified timeframe requirements.
  • Valid Driver’s License
  • 100 % day travel required
  • Employee may be required to participate in Runzhimer Program (auto reimbursement plan)
  • Various immunizations and/or associated medical tests may be required for this position.

Job Specific Requirements:

Grade 10 BBEX

Incentive Plan AEP

Number of Openings Available:

1

Worker Type:

Employee

Worker Sub-Type:

Telecommuter

Company:

VSHP Volunteer State Health Plan, Inc

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group.

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products in any form in Tennessee and where state law permits. A tobacco-free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a tobacco/nicotine test. An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn. Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

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