Health Care

applicant

Blue Cross Blue Shield of TennesseeThe 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. The institutional care coordinator is responsible for assessing the member's potential for and interest in transitioning from institutional facility care to home and community-based services care. Additionally, the institutional care coordinator implements and monitors the coordination of the member's physical health, behavioral health, and long-term care needs. This position is field based and requires travel to conduct face-to-face assessments with members. Positions are available throughout the East Region of Tennessee. Job Duties & Responsibilities:The Institutional Care Coordinator will perform the following essential activities of care coordination:Assessment - The institutional 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 for high cost medical care and develop a comprehensive plan of care that will address those needs.Planning - The institutional care coordinator will determine specific objectives, goals, and actions as identified through the assessment process. The transition plan and plan of care will be action oriented and time specific.Implementation - The institutional care coordinator will facilitate and execute specific interventions that will lead to accomplishing the goals established in the transition plan and plan of care to ensure the member's health, safety, and welfare while in a community-based setting.Coordination - The institutional care coordinator will organize, integrate and modify the resources necessary to accomplish the goals established in the transition plan and plan of care.Monitoring - The institutional care coordinator will gather sufficient information from all relevant sources in order to determine the effectiveness of the transition plan and plan of care.Evaluation - At appropriate and repeated intervals, the institutional 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 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 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.-Develop an individualized plan of care for transitioning members.-Proactively educate members about the program, including opportunities for consumer direction of HCBS, and obtain necessary consents for participation.-Ensure coordination of the member's physical health, behavioral health, and long-term care needs, which may include the identification of targeted needs related to improving health, functional, or quality of life outcomes, such as disease management or pharmacy management.-Monitor all aspects of the transition process and take immediate action to address any barriers that arise during transition.-For members transitioning to a setting other than a community-based residential alternative setting, monitor the initiation and daily provision of services in accordance with the member's new plan of care, and take immediate action to resolve any gaps in care.-Conduct monthly visits, face-to-face and/or telephonically, during the initial post-transition period.-Conduct ongoing needs reassessments as needed.-Conduct, review and revise, as necessary, member's risk assessment and risk agreement.-Monitor hospitalizations and institutional facility re-admissions to identify issues and implement strategies to improve transition outcomes.-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.-Establish working relations with institutional facilities, referral sources, community resources, and care providers.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 5 years healthcare experience with 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. -Basic PC computer skills required with emphasis on Microsoft Office applications preferred-Valid Driver's License-90% day travel required-Employee may be required to participate in Runzhimer Program (auto reimbursement plan)Please apply via our career site at:https://www.bcbst.com/about/careers/openings/