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 and home and community based services. The care coordinator supervisor is responsible for providing oversight of long-term care and home and community based coordination activities conducted by the care coordination team. The care coordination team promotes interdependent collaboration with the member, physician/primary care manager, and member's family through thorough and objective face-to-face assessment of the member to determine current status and needs; development of individualized care plans; identification and communication of opportunities for care intervention; coordination, authorization, and monitoring of services; proactive education; and routine assessment and monitoring of the member's status, needs, and progress. Travel will be required. Incumbent will be responsible for Shelby County.
Job Duties & Responsibilities
Supervise, direct, and evaluate a diverse group of health care professionals to assure effectiveness of consumer advocate, ancillary, discharge, institutional, care coordinator assistant and home and community-based care coordinator activities, which include, but are not limited to, routinely assessing and monitoring member's status, needs, and progress; developing individualized plans of care for members; managing critical transitions; coordinating appropriate treatments and services; identifying and communicating opportunities for care intervention; authorizing care services; monitoring and ensuring the provision of covered services as a cost-effective alternative; developing and implementing targeted strategies to improve health, functional, and quality of life outcomes; proactively educating members; conducting, reviewing, and revising member's risk assessment and risk agreement; maintaining appropriate and ongoing communications and collaborations with members, their authorized representatives, and providers; and reporting quantifiable impact, quality of care, and quality of life improvements as measured against care coordination goals.
Under the supervision of the care coordination manager, provide and/or coordinate staff training for maximum performance and provide developmental opportunities.
Promote teamwork and a positive working environment for the care coordination team.
Responsible for communicating and mentoring members of the care coordination team to ensure long-term and home and community based care guidelines, policies, and procedures are followed.
Monitor performance of staff including service performance and adherence to established utilization benchmarks.
May be required periodically to carry case load of members, when dictated by census fluctuations or staffing coverage.
Other duties deemed necessary for effective and efficient unit operations.
Must be willing to participate in Runzheimer Auto Reimbursement program
99% day - travel required
Overnight travel is periodically required
Registered nurse with an 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 Act; or Masters in Social Work with an active unrestricted license.
Minimum 2 years of relevant health care experience, preferably in managed and/or long-term care
3-5 years of supervisory/management experience required
3 years experience providing care coordination to persons receiving long-term care services preferred
Excellent communication, leadership, organizational, and problem prevention skills
Experienced and proficient with PC based software programs
Ability to manage multiple projects and priorities
Valid Drivers License
99% day travel required
Employee may be required to participate in Runzheimer Program (auto reimbursement plan)
BlueCross BlueShield of Tennessee - 23 months ago
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BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....