JOB SUMMARY
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizes data/analytics in conjunction with professional clinical judgement to identify the right clinical/lifestyle intervention for each member.The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources.The incumbent conducts outreach to members enrolled in disease management including but is not limited to, developing a personalized care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent engages with the member panel telephonically, digitally, or virtually to achieve improved health outcomes. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.
ESSENTIAL RESPONSIBILITIES
Maintain knowledge of evidence-based interventions and industry standards to deliver high quality lifestyle coaching in the areas of tobacco cessation, weight management, sleep hygiene, stress management, nutrition, physical activity and maternal health.
Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources (internal and external), and conduct a number of other activities to help improve the health outcomes of members; care plans include both long- and short-term goals and plan of regular contacts for re-assessment of progress towards goals.
Demonstrate clinical outcomes and cost savings based on wellness interventions and provide support to all members across all age bands, geographic regions, and products.
Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements,professional scope and accreditation standards.
Participates in workgroups focused on continually improving the efficiency, effectiveness, and member-centric focus of the wellness coaching services, including but not limited to the development and implementation of new programs and pilots.
Other duties as assigned or requested.
EDUCATION
Required
Master's Degree in Nutrition, Health Education, Health Promotion, Exercise Science, Public Health, Social Work/Psychology, Health or Clinical related field OR relevant experience and/or education as determined by the company in lieu of master’s degree
Preferred
None
EXPERIENCE
Required
3 years as a Registered Dietician OR Exercise Physiologist OR Wellness/Lifestyle Coach in an environment that focuses on a wellness model or program delivery (i.e. health plan/insurance, disease or condition management or inpatient/outpatient acute care)
Preferred
None
LICENSES or CERTIFICATIONS
Required
None
Preferred
Certified Tobacco Cessation specialist
Registered Dietician
Certified Diabetes Educator (CDE)
Exercise Physiology certification
Certified Lactation Counselor
National Diabetes Prevention Program Lifestyle Coach
Certified Health and Wellness Coach (CHWC)
SKILLS
Familiarity with Highmark’s preventative health services programs & services
Effective presentation skills
Strong relationship builder
Skilled in basic computer skills and software applications including Microsoft TEAMS.
Comprehensive knowledge and understanding of current health education practices
Knowledge of Prochaska’s Transtheoretical Stage of Change model
Experience working in a team environment that supports the management of health services and/or wellness program
Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
Ability to work in a high-performing team environment that requires flexibility
Demonstrated ability to handle multiple priorities in a fast-paced environment
Excellent organizational, time management and project management skills
Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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