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

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

Chronic Disease Coach, RN / Lactation Consultant

Key skills