Under the direction of the Care Management Manager, the Health Coach functions as the primary nurse to provide both health coaching and case management services to members across the continuum of health ranging from health promotion to end-of-life. Health coaches collaborate on care plan development and coordination with members and physicians by screening, assessing, planning, facilitating, monitoring and giving input when adjustment is needed, and advocating for the member on an individual basis. Health coaches use clinical and motivational interviewing skills to assess member’s need and establish mutually agreeable goals while supporting member in developing self-management skills in adopting positive behavior changes. Health Coaches work with the member to identify and address barriers to member’s adherence to standards of evidence-based medicine. The health coach facilitates communication between the patient, family, and members of the health care team while acting as an educator and link between the patient, providers and the plan, ensuring high quality, cost-effective services are delivered. Helps members coordinate care and navigate the healthcare system.
Duties and Responsibilities:
Functions as a primary nurse for members across the continuum of health and health-related services including information and support for lifestyle improvement, acute symptoms, treatment decisions, targeted health conditions, chronic conditions and complex conditions.
Engages with the members ranging from coaching to intensive case management with the goal to develop and support the member’s ability to self-manage.
Provides appropriate clinical coaching support to members placing in-bound calls seeking assistance with acute symptoms, chronic conditions and/or health information regarding, specific topics.
Conducts appropriate surveys/assessments to proactively identify needs. Develops appropriate care plans and establishes goals. Assessment includes working with member/family/significant other to identify barriers of adherence to the physician’s plan of care as well as achieving lifestyle improving goals. Continues to work with member via on-going telephonic communication to achieve the agreed upon goals.
Proactively incorporates lifestyle improvement and prevention opportunities into member interactions and coaching.
Contacts member’s physician when needed especially in more complex medical situations requiring case management intervention to facilitate care coordination.
Monitors the quality of service, seeking member/family input. Communicates safety issues to manager and utilizes the occurrence screening for quality-of-care tracking.
Identifies on-line, telephonic and community-based resources that can assist the member in achieving and maintaining their personal health goals. Assist the member in accessing those services. In addition, assist in maximizing the use of member’s benefits and ensuring coordination of services and outcomes.
Provides exceptional customer service.
Maintains and communicates accurate information in associate self-serve program.
Attends educational programs/training to maintain state license, CCMC licensure and updated knowledge of Health Coach process.
Ensures all activities are documented and conducted in compliance with applicable regulatory requirements and accreditation standards.
Other duties as assigned.
Qualifications:
Current, active, and unrestricted Pennsylvania (PA) or multi-state Registered Nurse licensure.
Three years any of combination of clinical, case management and/or disease/condition management experience.
Exceptional communication and problem-solving ability.
Ability to work flexible hours.
Basic computer skills.
Strong clinical knowledge.
Current, active, and unrestricted Pennsylvania (PA) Registered Nurse licensure.
Three years any of combination of clinical, case management and/or disease/condition management experience.
Exceptional communication and problem-solving ability.
Ability to work flexible hours.
Basic computer skills.
Strong clinical knowledge.
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
At Independence Blue Cross, all qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
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