Nurse Health Coach

The Role
As a HEDIS nurse health coach, you will be responsible for engaging members, providing community resources, and referring to case management—all to achieve maximum health outcomes. You will leverage your strong flexibility and cooperation skills and use targeted approaches to gather information in a timely manner to achieve the highest possible NCQA and CMS STARs ratings. The ability to change frequently is required to support team initiatives, including medical chart reviews and performance measurement and improvement programs.

The Team
As an integral part of the HEDIS HOS Intervention Team within Clinical Quality and Compliance, you will coordinate and collaborate with teams and associates inside and outside of HMM, including Care Management, Member and Provider Service, and Performance Measurement and Improvement.

Key Responsibilities:

• Make outreach calls to members with gaps in care to assure adherence with HEDIS/STARs measures and contact provider offices to promote coordination of care as needed
• Identify member barriers to obtaining care and provide education, discuss clinical services/benefits, identify appropriate resources, and make necessary referrals both internally and externally, to mitigate barriers
• Ensure timely and clinically appropriate documentation in all required systems and meet daily productivity goals
• Participate in assistance with performance, measurement and improvement with activities such as medical record reviews and provider outreaches
  • Perform in home screenings for appropriate Med Adv members, including encouraging the member to share results with their provider, documenting in BCBSMA system that screening took place, and following all requirement as outlined in policies/protocols
•  Key Qualifications:
  • Excellent organization, communication, technical, customer service and problem-solving skills
  • Knowledge of medical terminology, clinical data, and medical records
  • Ability to engage and obtain specific clinical information from members in a timely manner, in order to meet productivity while also serving our member’s needs
•  Education and Experience:
  • Registered nurse or equivalent health professional required
  • 2-3 years nursing experience in a clinical setting (medical surgical hospital, home health etc.)
  • Prior experience with older adults, Medicare preferred
  • Experience with clinical telephonic health coaching preferred

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.