Nurse Health Coach

Blue Cross Blue Shield of Massachusetts•Boston, MA

15d•$46 - $57

About The Position

As a HEDIS nurse health coach, you will engage members, provide community resources, and refer members to case management to support optimal health outcomes. You will use targeted approaches to gather information promptly and help achieve strong NCQA and CMS STARs ratings. Flexibility is required to support changing team initiatives, including medical chart reviews and performance measurement and improvement programs. The role is part of the HEDIS HOS Intervention Team within Clinical Quality and Compliance. It coordinates and collaborates with internal and external teams, including Care Management, Member and Provider Service, and Performance Measurement and Improvement. The position is based in Boston or Hingham and is full time.

Requirements

Registered nurse or equivalent health professional.
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 in a timely manner while meeting productivity expectations and serving members’ needs.
High school degree or equivalent, unless otherwise noted above.

Nice To Haves

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

Responsibilities

Make outreach calls to members with gaps in care to support adherence with HEDIS/STARs measures, and contact provider offices to promote care coordination as needed.
Identify barriers to care; educate members; discuss clinical services and benefits; identify resources; and make internal and external referrals to mitigate barriers.
Document information in required systems in a timely and clinically appropriate manner 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 providers, document completed screenings in the BCBSMA system, and follow applicable policies and protocols.