RN - Transitional Care Health Coach

Telligen - Lawton, OK

Full-time - Mid Level

Hybrid - Lawton, OK

Web Search Portals, Libraries, Archives, and Other Information Services

About the position

As an RN Health Coach for Transitional Care, you will provide health coaching to Oklahoma Medicaid members, focusing on assessment and evaluations for individuals with healthcare needs. This hybrid role involves working in a hospital at least one day per week and requires collaboration with healthcare providers to develop patient-centered action plans that promote wellness and self-management of chronic diseases.

Responsibilities

• Perform assessment and evaluation of patients with chronic disease per client contractual obligations.
• Evaluate the needs of individuals and families, obtain psychosocial history, assess needs, and link individuals and families with available psychological, health, and social services.
• Collect detailed information including medical, social, and financial information to aid in facilitating the appropriate treatment plan consistent with the patient's needs.
• Collaborate with health care providers and ancillary service providers to validate the appropriate individualized treatment and care plan.
• Ensure data necessary to report standard measures is collected as discreet data elements in the EHR or disease registry database.
• Actively engage with patients and families, utilizing motivational interviewing techniques.
• Teach self-management skills and support patients and families with chronic disease.
• Coordinate care management activities across the care continuum.
• Implement and teach quality improvement methods including Plan, Do, Study, Act, and use of data to office/clinic personnel and clinicians.
• Assemble data and information for regular reporting requirements maintaining confidentiality and sensitivity of protected health information.

Requirements

• Registered nurse in Oklahoma is required.
• Two or four-year degree in health care or a related field.
• 3+ Years of experience.
• Disease management experience.
• Certified Case Manager or similar advanced credentialing or ability to obtain certification within 2 years of hire.
• Excellent communication skills and organization.

Nice-to-haves

• Experience with motivational interviewing.
• Spanish-speaking candidates are preferred.

Benefits

• Health insurance coverage
• 401k retirement savings plan
• Paid holidays
• Flexible scheduling options