Blue Cross Blue Shield of Massachusetts: Registered Nurse as Health Coach in Quincy, MA

Job description Registered Nurse  as The Health Coach utilizes a proactive, accountable, member-centric model within the members’ health care delivery system. The Coach utilizes interventions designed to develop engaged and informed members while addressing their common chronic conditions. Functions of the Health Coach include:

  • Comprehensive needs assessments along with goals and a plan of care
  • Collaboration with prevention & wellness programs that increase awareness of health risks associated with risky behaviors and lifestyle choices
  • Member-centric health management goals and education inclusive of prevention, behavior modification, and care coordination between the member and the primary care provider
  • Self-management interventions aimed to promote behavioral changes for our members
  • Measurement and Continuous Process Improvement processes with a goal of improving quality and cost
  • May include some Utilization Management functions

Registered Nurse Education and Experience

  • Dealing w/ambiguity (Ability to adapt, demonstration of insight, self-direction, and self-discipline)
  • Flexibility/ Adaptability (Coping) (Adaptability, a calm demeanor and an understanding of the situation)
  • Ability to manage multiple projects in conjunction with patient caseload
  • Ability to utilize and demonstrate proficiency with Information Technology systems
    • Computer skills, Word, Excel, Access
    • Foster teamwork as attitude and skill
    • Proven customer service skills
  • Ability to manage complicated members with chronic disease and associated co-morbidities
  • Coaching skills (ability to educate members to address their health conditions and influence behavioral changes to improve health; set goals, identify obstacles and use appropriate resources)
  • Critical thinking / problem-solving skills (ability to analyze information to construct effective solutions)
  • Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)
  • Communication (ability to articulate complex concepts, verbally and in writing, indecisive and focused manner)
  • Builds effective relationships (ability to establish and maintain productive partnerships, internally and externally, in person and virtually, in order to facilitate professional and business goals)
  • Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)
  • Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)
  • Care to plan (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)
  • Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery)
  • Knowledge of clinical areas / specific member population (demonstrates the use of the right resources or guidelines to inform care plans; clinical experience in specific conditions or specialties)
  • Business Insight (Demonstrates an understanding of the chronic condition management process and its business implications and awareness of current / future policies, practices, trends, and information affecting the business and organization)
  • Healthcare provider with active professional Massachusetts license required
  • Registered Nurse with active professional Massachusetts license preferred; Licensure in additional states a plus
    • 3-5 years of clinical experience in medical/surgical care
    • Bachelor’s degree preferred
    • Case management experience and CCM preferred
    • Home care experience plus; prior experience in disease management preferred

This job description is not intended to be all inclusive and this role may have additional responsibilities as assigned by a leader.

The principles and core technology of chronic condition management are applied to members across various product lines, benefits, demographics, conditions, and programs.

Key Accountabilities:

  • Implement condition management to focused population that includes management of disease-specific and co-morbid conditions for all eligible members, across continuum of care
  • Engage and motivate members to participate in the condition management program by clearly articulating the goals, benefits, and interventions provided
  • Identify member’s acceptance and readiness to change, provide strategies to motivate and counsel members to change behaviors
  • Facilitate communication between members/families, providers, medical staff and vendors with information relating to medical management, benefits, and the care/case management process
  • Collaborate with members/families, providers, medical staff and/or others in order to coordinate and support treatment plans that include treatment goals, interventions and expected clinical outcomes
  • Educate members/families regarding benefits, disease process, and community/other resources with a goal of empowering self-advocacy and self-management plan
  • Administer member’s benefits to manage health care dollars efficiently and effectively
  • Educate members regarding their disease process and self-management strategies
  • Articulate to providers and members goals, intent and interventions for disease management program
  • Foster clinical excellence by promoting and participating in educational opportunities

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