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Role Description

The Transitions of Care RN- 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.

• 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.
• Refers member to catastrophic case management.

Qualifications

• 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.

Requirements

• RN compact license is highly preferred.
• BS in nursing preferred.
• Prior case management experience preferred.
• Bilingual in Spanish or Mandarin is highly preferred.
• Experience working with members that have chronic diseases is highly preferred.
• Experience working in home health is preferred.

Benefits

• Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
• 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.