Nurse Health Coach

Ready to help us transform healthcare? Bring your true colors to blue.

The Role

As a HEDIS nurse health coach , you will be responsible for engaging members , providing community resources, and referring to case management—all to achieve maximum health outcomes. You will leverage your strong flexibility and cooperation skills and use targeted approaches to gather information in a timely manner to achieve the highest possible NCQA and CMS STARs ratings. The ability to change frequently is required to support team initiatives , including medical chart review s and performance measurement and improvement programs. The Team As an integral part of the HEDIS HOS Intervention T eam within Clinical Quality and Compliance , you will coordinate and collaborate with teams and associates inside and outside of HMM, including Care Management, Member and Provider Service, and Performance Measurement and Improvement .

Key Responsibilities:

• Make outreach calls to members with gaps in care to assure adherence with HEDIS/STARs measures and contact provider offices to promote coordination of care as needed

• Identify member barriers to obtaining care and provide education, discuss clinical services/benefits, identify appropriate resources , and make necessary referrals both internally and externally, to mitigate barriers

• Ensure timely and clinically appropriate documentation in all required systems and meet daily productivity goals

• Participate in assistance with performance, measurement and improvement with activities such as medical record reviews and provider outreaches

• Perform bone density screenings for appropriate Med Adv members, including encouraging the member to share results with their provider, documenting in BCBSMA system that screening took place, and following all requirement as outlined in policies/protocol

Key Qualifications:

• Excellent organization, communication, technical, customer service and problem-solving skills

• Knowledge of medical terminology, clinical data, and medical records

• Ability to engage and obtain specific clinical information from members in a timely manner , in order to meet productivity while also serving our members’ needs

• Must possess active driver’s license, vehicle to travel and ability to lift 20 pounds to complete member screening visits

Education and Experience :

• Registered nurse or equivalent health professional required

• Prior experience with older adults, Medicare preferred

• Experience with clinical telephonic health coaching preferred

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationHinghamTime TypeFull time

Hourly Range: $46.43 - $56.75

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap ( and imposter syndrome ( can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture ( page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community ( to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work ( " Page.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.