Health Coach Case Manager

Registered Nurse (RN)

JOB SUMMARY:

Responsible for patient advocacy, health decision support, and coaching services for participants as they utilize health benefits provided by Plan, coordinating a multidisciplinary team approach to program services and health improvement. Team participation with primary care physicians, clinic staff, and patients in assisting participant engagement in self care and enhancing patient understanding of their health conditions. Responsible to ensure coordination between medical home and specialty services, and assisting with closing care gaps identified through the patient registry.

Enter and track key clinical results, activities, and indicators in the patient registry. Develop and implement patient training curricula, motivational interviewing methods, and outcomes tracking related to patient engagement in weight management, fitness improvement, smoking cessation, blood pressure control, hyperlipidemia control, diabetes control, asthma control, stress management, musculoskeletal pain management, medication adherence, and avoidance of drug, alcohol, and substance abuse.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Organization, direction, and evaluation of Participant Health Advocacy Services, includes planning, program leadership, care coordination, documentation and results tracking.
• Participate in the implementation and management of patient engagement processes, with responsibility to ensure health risk assessment (HRA), medical home selection, transitions of care between health care settings, and care plan implementation.
• Develop, implement, manage and monitor participant benefit education and health promotion programs.
• Educate, guide, motivate and support Plan Participants - helping people navigate through the emotional, mental and physical challenges of behavior change.
• Build patients’ confidence so that they have the power to accomplish their goals; helping them take responsibility for their decision making and behaviors; helping build the self-efficacy and self-care skills they need to effectively self-manage their health improvement objectives.
• Develop structure that supports coordinated continuity care through the medical home.
• Assure timely and effective resolution of participant complaints through direct investigation, liaison with appropriate staff, communication with clinical staff, and coordination of responses to participants and their families.
• Recommend needed changes in policies, procedures, programs, or services to Plan staff, Plan sponsors, and/or representatives of primary care and specialist providers.
• Represent participant clinical perspective and patient experience to Plan management team.
• Other duties as assigned.

EDUCATION & QUALIFICATIONS:

1.       Registered Nurse with case management / patient advocacy / health coaching experience required.

2.       Minimum of 5 years experience in direct patient care, health management, or managed care services required plus or including a minimum of 3 years supervisory experience.

3.       Fluency in Spanish desired (written & verbal)

SKILLS & ABILITIES:

•          Excellent communication skills including written, verbal, presentation and advocacy.

•          Strong analytical and educational skills including problem solving, negotiation, the ability to generalize, illustrate, identify trends, and summarize information.

•          Superior interpersonal skills including the ability to motivate patient engagement in self management of chronic and high risk conditions and the ability to work in a team environment, e.g., flexibility, maturity, ability to successfully manage complex situations, empathy, sensitivity and tact. Serve as a role model in healthy behaviors.

 
Have demonstrated clinical ability to:

o        Build a therapeutic relationship with client

o        Assess client’s needs

o        Determine potential for null or negative outcome and adjust counseling accordingly

o        Determine and provide relevant community and/or healthcare resources to help support client’s solution for change

o        Help client work towards forming solutions for presenting problem

o        Establish a plan of action with client

o        Work with a team of professionals in a way that supports a positive clinical outcome for all clients

•          Demonstrate ability to multi-task including managing a multi-line phone system; use of multiple, concurrent software programs and responding to a variety of interpersonal tasks and requests.

•          Knowledge of mental health laws and ethics.

•          Demonstrated proficiency with common computer based applications such as electronic mail, word processing and various databases, whether PC, network or mainframe based.