RN Chronic Disease Coach

BlueCross BlueShield of South Carolina

3d•Remote

About The Position

Provide support to members for disease prevention and healthy promotion. Empower members to achieve optimal health and wellness by providing personalized guidance, education, and support. This role collaborates with individuals to set and reach health goals, navigate the healthcare system, and make informed decisions about their well-being within the context of their health plan benefits. Description Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote. The candidate will be required to report on-site for their first day.

Requirements

Associate's in job related field Degree Equivalency: Graduate of Accredited School of Nursing OR graduate of a health-related degree OR 2 years job related work experience
3 years of professional health and wellness experience
Working knowledge of word processing software.
Knowledge of quality improvement processes and demonstrated ability with these activities.
Knowledge of contract language and application.
Ability to work independently, prioritize effectively, and make sound decisions.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated proficiency in spelling, punctuation, and grammar skills.
Demonstrated oral and written communication skills.
Ability to persuade, negotiate, or influence others.
Analytical or critical thinking skills.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office
Within 4 years of hire, must get certification in health coaching (ex: National Board Certified Health and Wellness Coach).

Nice To Haves

Graduate of Accredited School of Nursing
5 years - healthcare management
Health Coaching Certification
Working knowledge of spreadsheet, database software.
Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.

Responsibilities

Assess for needs related to a member’s chronic condition, clinical risk and readiness for change via company needs questionnaire.
Based on the needs assessment, complete and coordinate action plans in cooperation with members, then implement plans to include member goals.
Provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to elicit behavior change and increase member program engagement.
Participates in patient education with members and providers regarding the member’s condition and available benefit plans.
Serves as member advocate through continued communication and education.
Promotes enrollment in health and chronic condition management programs.
Provides appropriate communications (written, telephone) regarding member conditions to both health care providers and members.
Participates in data collection/input into system for clinical information flow.
Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
Maintains current knowledge of network status of all service providers to educate members on care they may receive related to their chronic condition(s).
Assists members with referrals to appropriate internal support areas to ensure proper processing of authorized or unauthorized services, as needed.