RN Disease Mgmt - Clinical Quality (HEDIS) - CareBridge

About the position Nurse Disease Management I LOCATION : This is a virtual eligible role. You should be within a reasonable distance of one of our offices. HOURS : 8:00am - 5:00 pm, local time. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases. This position focuses on assessing member compliance and closing HEDIS® care gaps. Evaluate adherence to treatment plans via phone outreach and medical record reviews, lead and support efforts to meet or exceed HEDIS®/Stars goals, identifying opportunities to improve quality outcomes, and recommending process improvements, and coaching others to master HEDIS® guidelines.

Responsibilities

• Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs.
• Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments.
• Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
• Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs.
• Uses motivational interviewing to facilitate health behavior change.
• Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed.
• Directs members to facilities, community agencies and appropriate provider/network.

Requirements

• Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in applicable state(s) required.

Nice-to-haves

• 2+ years HEDIS MRRV experience is a must for this role.
• HEDIS® technical specifications knowledge/experience is a must for this role.
• RN compact license is strongly preferred.
• Experience working with members that have chronic diseases is strongly preferred.
• BS/BA degree in nursing or a healthcare related field is preferred.
• Experience working in home health or care management is preferred.
• Bilingual skills are very helpful.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.