Role Description
The Transitions of Care RN 100% Virtual, CareBridge is 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.
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Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs.
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Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments.
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Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
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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.
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Uses motivational interviewing to facilitate health behavior change.
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Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed.
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Directs members to facilities, community agencies and appropriate provider/network.
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Refers member to catastrophic case management.
Qualifications
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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.
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Current unrestricted RN license in applicable state(s) required.
Requirements
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RN compact license is highly preferred.
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BS in nursing preferred.
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Prior case management experience preferred.
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Bilingual in Spanish is highly preferred.
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Experience working with members that have chronic diseases is highly preferred.
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Experience working in home health is preferred.
Benefits
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Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
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Incentive bonus programs (unless covered by a collective bargaining agreement).
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Medical, dental, and vision benefits.
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Short and long term disability benefits.
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401(k) + match.
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Stock purchase plan.
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Life insurance.
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Wellness programs and financial education resources.