Nurse Health Coach
About The Position
Ready to help us transform healthcare? Bring your true colors to blue. The Role As a HEDIS nurse health coach, you will be responsible for engaging members, providing community resources, and referring to case management—all to achieve maximum health outcomes. You will leverage your strong flexibility and cooperation skills and use targeted approaches to gather information in a timely manner to achieve the highest possible NCQA and CMS STARs ratings. The ability to change frequently is required to support team initiatives, including medical chart reviews and performance measurement and improvement programs. The Team As an integral part of the HEDIS HOS Intervention Team within Clinical Quality and Compliance, you will coordinate and collaborate with teams and associates inside and outside of HMM, including Care Management, Member and Provider Service, and Performance Measurement and Improvement.
Requirements
- Excellent organization, communication, technical, customer service and problem-solving skills
- Knowledge of medical terminology, clinical data, and medical records
- Ability to engage and obtain specific clinical information from members in a timely manner, in order to meet productivity while also serving our members’ needs
- Must possess active driver’s license, vehicle to travel and ability to lift 20 pounds to complete member screening visits
- 3-5 years of clinical experience
- Registered nurse or equivalent health professional required
Nice To Haves
- Prior experience with older adults, Medicare preferred
- Experience with clinical telephonic health coaching preferred
Responsibilities
- Make outreach calls to members with gaps in care to assure adherence with HEDIS/STARs measures and contact provider offices to promote coordination of care as needed
- Identify member barriers to obtaining care and provide education, discuss clinical services/benefits, identify appropriate resources, and make necessary referrals both internally and externally, to mitigate barriers
- Ensure timely and clinically appropriate documentation in all required systems and meet daily productivity goals
- Participate in assistance with performance, measurement and improvement with activities such as medical record reviews and provider outreaches
- Perform bone density screenings for appropriate Med Adv members, including encouraging the member to share results with their provider, documenting in BCBSMA system that screening took place, and following all requirement as outlined in policies/protocol
Benefits
- We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
11-50 employees
