The Role
As aHEDISnurse health coach, you willbe responsible forengaging members,providing community resources, and referring to case management—all to achieve maximum health outcomes.Youwillleverageyour strongflexibilityand cooperationskills and use targeted approaches to gather informationin a timely mannerto achieve the highest possible NCQA and CMS STARs ratings. The ability to changefrequentlyisrequiredtosupportteam initiatives, includingmedical chart reviews and performancemeasurement and improvementprograms.
The Team
As an integral part of theHEDIS HOS InterventionTeam within Clinical Quality and Compliance, you willcoordinate and collaborate with teams and associates inside and outside of HMM, includingCare 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
Identifymember barriers to obtaining care and provide education, discuss clinical services/benefits, identifyappropriate resources, and make necessary referrals both internally and externally, to mitigate barriers
Ensuretimelyand clinicallyappropriate documentationin all required systems and meetdailyproductivity goals
Participate inassistancewith performance,measurementand improvement with activities such as medical record reviews and provider outreaches
Perform bone density screenings forappropriate Med Advmembers, 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/protocol
KeyQualifications:
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 membersin a timely manner,in order tomeet productivity while also serving ourmembers’needs
Mustpossessactive driver’s license, vehicle to travel and ability to lift 20 pounds tocomplete member screening visits
Education and Experience
Registered nurse or equivalent health professionalrequired
Prior experience with older adults, Medicare preferred
Experience with clinical telephonic health coaching preferred
High school degree or equivalent required unless otherwise noted above
Hingham
Full timeHourly Range: $46.43 - $56.75
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.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our " How We Work" Page.
Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 80 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 3 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation or gender identity.
ATTENTION: If you don’t speak English, language assistance services, free of charge, are available to you. Call Member Services at the number on your ID Card (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación (TTY: 711).
ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID (TTY: 711).
