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Chronic Disease Coach, RN / Lactation Consultant
BlueCross BlueShield of South CarolinaChronic Disease Coach providing personalized guidance and support for members’ health and wellness. Collaborating with individuals to set and reach health goals within their health plan benefits.
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- Associate's in job related field
- Graduate of Accredited School of Nursing OR graduate of a health-related degree OR 2 years job related work experience
- 3 years of professional health and wellness experience
- 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
Benefits
Comp & perks- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
motivational interviewingreflective listeningdata collectionquality improvement processescontract languageclinical risk assessmentchronic condition managementpatient educationaction plan coordinationhealth program enrollment
Soft Skills
customer serviceorganizational skillspresentation skillsoral communicationwritten communicationpersuasionnegotiationindependent workprioritizationcritical thinking
Certifications
Associate's degree in job related fieldGraduate of Accredited School of NursingHealth-related degree