Assists with implementation of health management activities/programs for BlueCross BlueShield of South Carolina (BCBSSC) and/or BlueChoice members.
Contract: 02/06/2023 - 05/06/2023
•40% Assists with implementation of health management activities/programs for membership. Coordinates all aspects of assigned programs. Facilitates program to participants and focuses emphasis on high risk members. Follows/updates established procedures. Provides health coaching telephonically or in person for assigned health programs. Utilizes all data systems containing patient information and documents information appropriately.
•25% Assists with development of strategies to increase effectiveness of and participation in health management programs. Establishes/maintains effective communications with provider network, group representatives and members.
•20% Conducts research and analysis of reports (monthly, quarterly, annually). Adheres to policies and works toward attainment of program goals. Monitors member compliance and success rates.
•15% Assists with identification of areas for which there is a need for health management programs. Monitors quality indicators and develops programs to positively impact areas where improvement is warranted. Develops patient/provider educational materials for members/providers.
Skills: Required Skills and Abilities: Working knowledge of word processing, spreadsheet, database, and presentation software. Understanding of insurance and benefit programs as it relates to health management coverage. Knowledge of the quality improvement process. 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. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Preferred Skills and Abilities: Working knowledge of database software. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Work Environment: Typical office environment. May involve some travel.
ADDITIONAL SKILL SET: Prefer LPN – long term care, med-surg, care management, disease management, home health background strongly preferred. Need very strong computer and telephone skills to succeed.
Education: Required Education: Bachelor's degree - Nursing, Health Administration, Health Promotion, Exercise Science, Education/Training, Social Work, or health-related field. or If Maternity Management Coordinator/Counselor: 4-year degree in Health Promotion or related field OR 2-year degree and 2 years experience in healthcare environment or as a Certified Childbirth Educator/Prenatal Educator, OR graduate of an approved LPN program and 2 years experience in maternity management healthcare environment. If Diabetes Management Coordinator/Counselor: 4-year degree in Health Promotion, Nutrition, or related field or Certified Diabetes Educator OR graduate of an approved LPN program and 2 years experience in diabetes management healthcare environment. If Asthma Management Coordinator/Counselor: 4-year degree in Health Promotion, Exercise Science, or related field or Certified Asthma Educator or RRT (Registered Respiratory Therapist). If Master's, 1 year experience may also be in Exercise Science, Nutrition, Physical Therapy, or other health-related degree. If Wellness Coach/Health Promotion: 4-year degree in Health Administration, Health Promotion, Exercise Science, Education/Training, or health-related field. Required Work Experience: 3 years clinical in defined specialty and/or facilitating health education and prevention programs, OR, 4 years experience in Health Administration or health-related field, OR, 2 years experience if Master's degree in Health Promotion, or Health Administration, or health-related field. Required Licenses and Certificates: If RN, active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC); if LPN, active, unrestricted LPN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC).
Preferred Education: Bachelor's degree- Health Education/Health Management, Healthcare Administration, or Social Work, or Health Promotion.
Preferred Work Experience: 3 years-healthcare program management.
Preferred Licenses and Certificates: Active, unrestricted LBSW (Licensed Bachelor of Social Work) licensure from the United States and in the state of hire.
$20 - $23 per hour