JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizes data/analytics in conjunction with professional clinical judgement to identify the right clinical/lifestyle intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. The incumbent conducts outreach to members enrolled in disease management including but is not limited to, developing a personalized care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent engages with the member panel telephonically, digitally, or virtually to achieve improved health outcomes. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members. ESSENTIAL RESPONSIBILITIES Maintain knowledge of evidence-based interventions and industry standards to deliver high quality lifestyle coaching in the areas of tobacco cessation, weight management, sleep hygiene, stress management, nutrition, physical activity and maternal health. Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources (internal and external), and conduct a number of other activities to help improve the health outcomes of members; care plans include both long- and short-term goals and plan of regular contacts for re-assessment of progress towards goals. Demonstrate clinical outcomes and cost savings based on wellness interventions and provide support to all members across all age bands, geographic regions, and products. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements, professional scope and accreditation standards. Participates in workgroups focused on continually improving the efficiency, effectiveness, and member-centric focus of the wellness coaching services, including but not limited to the development and implementation of new programs and pilots. Other duties as assigned or requested.
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Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees