Nurse Health Coach

Blue Cross Blue Shield of Massachusetts•Boston, MA

13d

About The Position

As a HEDIS nurse health coach, you will engage members, provide community resources, and refer members to case management to help achieve optimal health outcomes. You will use targeted approaches to gather information promptly and support high NCQA and CMS STARs ratings. The role requires flexibility to support changing team initiatives, including medical chart reviews and performance measurement and improvement programs. You will be part of the HEDIS HOS Intervention Team within Clinical Quality and Compliance, coordinating and collaborating with teams and associates inside and outside of HMM, including Care Management, Member and Provider Service, and Performance Measurement and Improvement. The role includes outreach calls, member education and referrals, documentation, performance improvement activities, and in-home screenings for appropriate Medicare Advantage members.

Requirements

Registered nurse or equivalent health professional required.
2–3 years of nursing experience in a clinical setting, such as a medical-surgical hospital or home health.
Excellent organization, communication, technical, customer service, and problem-solving skills.
Knowledge of medical terminology, clinical data, and medical records.
Ability to engage members and obtain specific clinical information promptly while meeting productivity goals and serving members’ needs.
High school degree or equivalent required unless otherwise noted above.

Nice To Haves

Prior experience with older adults; Medicare experience preferred.
Experience with clinical telephonic health coaching preferred.

Responsibilities

Make outreach calls to members with gaps in care to support adherence with HEDIS/STARs measures, and contact provider offices to promote coordination of care as needed.
Identify barriers to care; educate members; discuss clinical services and benefits; identify appropriate resources; and make internal or external referrals to mitigate barriers.
Complete timely and clinically appropriate documentation in required systems and meet daily productivity goals.
Assist with performance measurement and improvement activities, including medical record reviews and provider outreach.
Perform in-home screenings for appropriate Medicare Advantage members, encourage members to share results with their provider, document screenings in the BCBSMA system, and follow applicable policies and protocols.