Clinical Team Expert

Join Our Team as a Clinical Team Expert at BCBST’s Transition of Care Department!

The Transition of Care (TOC) department at BCBST is thrilled to welcome a new Clinical Team Expert. If you excel in discharge planning and transitioning members between various levels of care, we want to hear from you!

What You’ll Do:

• Collaborate directly with the TOC supervisor and manager to support the Transition of Care team.
• Facilitate seamless transitions for our members, ensuring they receive the best possible care across different levels.
• Communicate consistently with the Transition of Care team, supervisor, and manager.
• Monitor calls, manage reports, and address team members’ questions.

What Sets This Role Apart:

• Be a key player in enhancing our member care experience.
• Engage in dynamic teamwork and direct communication with leadership.
• Play a crucial role in shaping our transition processes.

Join us and make a meaningful impact on patient care as part of an innovative and dedicated team! Apply today!

Job Responsibilities

• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Support team with utilization management, case management, and/or behavioral health functions to ensure department performance goals are met.
• Performing quality audits and reviewing audit findings, providing feedback and training to staff as needed regarding clinical or technical information.
• Functioning as Team Leader, Subject Matter Expert and resource to the department as well as other areas within the organization as needed.

Job Qualifications

Experience

• 3 years - Clinical experience, or relevant work experience as a social worker, case manager or allied health services required.

Skills\Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Proven decision making and problem solving skills
• Effective and concise presentation skills
• In-depth knowledge of BCBSTs medical policies and criteria

License

• Current, active Tennessee license in: Nursing (RN), Masters level Social Work (LMSW), or Allied Health Services degree with an active unrestricted license required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
• For Shared Health contracts, employee must be licensed in and reside in the state of applicable contract and travel throughout the state of said contract

Number of Openings Available:

Worker Type:

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Applying for this job indicates your acknowledgement and understanding of the following statements:

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 any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

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 (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine 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 background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

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