BlueCross BlueShield of South Carolina

Compensation

Full Description

Summary Provide support to members for disease prevention and healthy promotion. Empower members to achieve optimal health and wellness by providing personalized guidance, education, and support. This role collaborates with individuals to set and reach health goals, navigate the healthcare system, and make informed decisions about their well-being within the context of their health plan benefits Description Logistics: This is a full-time remote position based in South Carolina, open only to candidates residing in the state. What You'll Do: 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. Required Education: Associate's in job related field Degree Equivalency: Graduate of Accredited School of Nursing or graduate of a health-related degree or 2 years job related work experience Required work experience: 3 years of professional health and wellness experience Required skills and abilities: 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. Software and other tools: Microsoft Office Licenses and Certifications: Within 4 years of hire, must get certification in health coaching (ex: National Board Certified Health and Wellness Coach). Preferred Education: Bachelor's degree in health-related field (e.g. Nursing, Social Work, Health Ed, Wellness, Health Promotion, Behavioral Health) Preferred Work experience: 5 years - healthcare management Preferred Specialized Training: Health Coaching Certification Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Work environment: Typical office environment. Employee may work form one's/out of one's home. May involve some travel within one's community. Onsite training may be required depending on the employee's performance and development needs. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.