Job Description
Location Address: 9521 San Mateo NEAlbuquerque, NM 87113-2237
Compensation Pay Range: Minimum Offer $62,400.00Maximum Offer $95,305.60
Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Disease Management Health Coach-RN to join our team.
How you grow, learn and thrive matters here. • Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system
Type of Opportunity: Full timeFTE: 1.00Job Exempt: YesWork Shift: Days (United States of America)
Responsibilities: Now hiring a
Disease Management Health Coach-RN Serves as a
health coach for members identified as needing
disease management services. Through
telephonic interventions the health coach will assess the member s learning needs, readiness to change, and gaps in care related to the member s chronic condition. The health coach provides education, self-management tools, and information to assist the member in achieving behavioral lifestyle changes to reduce risk and improve health outcomes. The health coach works in collaboration with the primary care provider and care team to take action on gaps in care related
Medicare Star and Medicaid HEDIS performance
Some key responsibilities include:
- Utilizes the nursing process to provide direct patient care and health coaching for disease management using telephonic methods and interactive video visits.
- Assesses members for readiness to make behavioral lifestyle changes.
- Uses adult learning principles to facilitate behavior change and patient empowerment.
- Follows evidence-based care guidelines for disease-state management.
- Uses advanced nursing assessment and critical thinking to assess the member s health care needs.
- Provides coaching and education to members related to disease specific self-management goals and behavioral lifestyle changes.
- Educates member about health condition, symptoms, and how choices can impact health outcomes.
- Uses a holistic approach to identify and take action on social determinants of care to include referrals to members of the health care team and community resources.
- Successfully works within the constraints of the role by recognizing when a referral to a different level of care is indicated and initiates referral to Nurse Advice Line, Case Management, Care Coordination, Community Health Worker, or community resources, when appropriate.
- Works with member to establish a self-management goal(s) and develops education and coaching plan to support lifestyle modifications and to promote a healthy lifestyle.
- Documents health coaching interventions in care management system.
- Provides ongoing communication to the member s primary care provider and care team regarding the member s self-management goals and progress towards goals,
- Identifies gaps in care related to the member s chronic condition and preventive screening needs related to age and gender. Places orders on behalf of the primary care provider using approved nursing protocols.
- Collaborates with member, caregivers, providers, and other healthcare team members to develop a comprehensive plan of care.
Qualifications: - Associates Degree
- New Mexico Registered Nursing License required.
- Three years of experience in nursing required. Ability to perform nursing assessments, conduct behavioral coaching and disease management education utilizing established tools and criteria.
- Ability to assess members for readiness to change behaviors.
- Ability to communicate telephonically and via interactive electronic communication with members and providers.
- Computer knowledge and skill to include Windows, word processing and database systems.
- Strong customer service skills. Computer literacy to include maintaining spreadsheets, charts, and tables of data and statistics in accordance with quality measures and utilization standards.
We're all about well-being, starting with yours. Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.
Learn more about our employee benefits.
About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services
Job Tags
Immediate start, Remote work, Shift work, Night shift, Weekend work