Chronic Disease Coach

Join our team in Columbia, SC, where you will have the opportunity to make a meaningful impact on the lives of individuals managing chronic diseases. Our organization is committed to providing exceptional support and guidance to our members, helping them achieve optimal health and wellness.

• Provide support to members for disease prevention and health promotion.
• Empower members to achieve optimal health and wellness by providing personalized guidance, education, and support.
• Collaborate 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.
• Assess needs related to a member’s chronic condition, clinical risk, and readiness for change via company needs questionnaire.
• Complete and coordinate action plans in cooperation with members, then implement plans to include member goals.
• Provide member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to elicit behavior change and increase member program engagement.
• Participate in patient education with members and providers regarding the member’s condition and available benefit plans.
• Serve as member advocate through continued communication and education.
• Promote enrollment in health and chronic condition management programs.
• Provide appropriate communications (written, telephone) regarding member conditions to both health care providers and members.
• Participate in data collection/input into system for clinical information flow.
• Demonstrate 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).
• Maintain current knowledge of network status of all service providers to educate members on care they may receive related to their chronic condition(s).
• Assist members with referrals to appropriate internal support areas to ensure proper processing of authorized or unauthorized services, as needed.

Typical office environment. Employee may work from home. May involve some travel within the community.

• 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.
• Proficiency in spelling, punctuation, and grammar skills.
• 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

• Working knowledge of spreadsheet, database software.
• Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.