RN Chronic Disease Coach

Overview

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.

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.

• 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.

• Required
  
  Education:
  
  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
• Required work experience: 3 years of professional health and wellness experience
• Required skills and abilities: 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.
• Software and other tools: Microsoft Office
• Licenses and
  
  Certifications:
  
  Within 4 years of hire, must get certification in health coaching (ex: National Board Certified Health and Wellness Coach).

• Preferred Education: Graduate of Accredited School of Nursing
• Preferred
  
  Work experience:
  
  5 years - healthcare management
• Preferred Specialized Training: Health Coaching Certification
• Preferred
  
  Skills and Abilities:
  
  Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Blue Cross Blue Shield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight,…