Facility: 531 Roselane Street NW

Overview
The Population Health Coach will serve as a key member of the Population Health Care Management Team, partnering with RN Care Managers, Social Workers, Pharmacists and Dieticians, Primary Care Providers, and other clinical staff to support patients in their journey to achieve optimal health and well-being.

The role of the Health Coach includes the following responsibilities:

1.Outreach and engagement with attributed patients identified through patient registries, risk stratification systems and analytics. The Health
Coach will utilize phone, email, MyChart and educational materials to engage and enroll these participants into a health coaching program.

2.Using motivational interviewing and standardized assessments, including assessments of patients' physical activity, dietary habits, cigarette
smoking habits, and social and economic resources, will assist patients in identifying health goals and establish a mutual ongoing plan of
care.

3.Utilize general knowledge of medical conditions, nutrition, physical activity, and risk reduction to provide ongoing education, support and
guidance to help patients improve self-management of their chronic condition(s)

4.Provide ongoing education, support, and guidance to reduce or eliminate high-risk health behaviors.

5.Engage key family members and care givers in supporting the patient and promoting self-management in their health and wellness journey.

6.Support the RN/Social Worker Case Manager in coordinating transitions of care, identifying appropriate community resources and needs and
implementing the plan of care. May serve as a liaison to providers, patients, and their families for coordination of services.

7.May also conduct follow-up phone calls, as assigned, for lower-risk patients, discharged from the emergency department or from an acute
hospital stay.

8.Documents all activities in EPIC, according to standardized guidelines and templates with completion in a timely manner.

9.Comply with tracking and reporting requirements for outcomes and evaluations.

10.Serve as a trusted, collaborative team member by escalating more complex issues or changes in patient status to the RN Care Manager,
participating in team meetings, seeking continuous improvement, and participating in ongoing educational opportunities.

11.Demonstrates commitment to providing outstanding customer service reflective of WellStar's Mission, Vision, and Values.


Responsibilities
Core Responsibilites and Essential Functions

* Knowledge, Skills, and Abilities

* Support behavior change: Utilize coaching techniques and motivational interviewing to support clients in making
sustainable behavior changes. Help clients overcome obstacles, develop self-awareness, and cultivate a positive
mindset towards their health goals.
* Monitor progress and adjust plans: Regularly track clients' progress, assess their adherence to the health plan, and
make necessary adjustments to optimize outcomes. Provide ongoing support, encouragement, and accountability to
ensure clients stay motivated and on track.
* Coordinate with healthcare professionals: Collaborate with other healthcare professionals, such as physicians,
dietitians, and therapists, to ensure holistic and integrated care for clients. Communicate relevant information and
recommendations to ensure continuity of care.
* Stay updated on health trends: Stay abreast of the latest research, trends, and developments in health and
wellness.
* Continuously enhance your knowledge and skills through professional development opportunities and relevant
certifications.

Patient Education
* Contacts and performs initial interviews with individuals who are eligible for health coaching programs
* Provides necessary coaching to reduce or eliminate behaviors that are considered high-risk.
* Distributes health education materials to patients.
* Coordinates with patients and other health care providers to provide coordinated care across the continuum
* Provides reminders to patients about needed for preventative care, assists in scheduling and obtaining results to
update health maintenance.
* Provides follow up when patients have not kept important referrals with physicians and specialists and other
ambulatory appointments.

Documentation

* Ensures chart notes accurately and timely reflects work and adherence to Departmental Standards
* Ensures all records are up-to-date and legible.
* Completes all Electronic Health Record software screens
* Accounts for and indicates all services delivered in the Electronic Health Record
* Participates in data collection.
* Consults appropriate experts and uses appropriate resources and evidence to address practice questions.

Required for All Jobs

Performs other duties as assigned

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Qualifications
Required Minimum Education

Bachelor's Degree Bachelor's degree in health sciences, nutrition, exercise science, psychology, or a masters degree is a plus Required and

Other Education National Board-Certified Health and Wellness Coach. Required

Required Minimum Experience

Minimum 2 years 1-2 years’ experience working in ambulatory care, home health, physician practice, other community setting, or hospital in patient support or advocacy. Required

Required Minimum Skills

Proven experience in health coaching or a related role, preferably in a clinical or corporate wellness setting is preferred

Strong knowledge of health and wellness principles, including nutrition, exercise, stress management, and behavior change

Active listening skills to understand clients' needs, concerns, and goals.

Ability to create personalized plans and adapt them to individual circumstances.

Empathy and a non-judgmental approach to support clients through their health journey.

Ability to tap into the unseen or root causes of client’s condition and help client make positive changes.

Strong organizational skills and ability to manage multiple clients and prioritize tasks effectively.

Adherence to professional ethics and standards of conduct.

Excellent communication and interpersonal skills to establish rapport with clients and motivate them effectively.

Ability to analyze, plan and think critically and problem-solve effectively.

Ability to organize, prioritize and be flexible, and work with a variety of teams.

Self-motivated, and ability to adapt to changing patient or organizational priorities.

Strong attention to detail.

Demonstrate and maintain high level of accuracy

Proven customer relations skills with patients with diverse backgrounds.

Knowledge of Population Health and Case Management processes.

Excellent organizational and professional communication skills both verbal and written.

Computer literacy, data entry, retrieval and report generation

Proficiency with Microsoft office suite products., technology and health related software.

Knowledge of HIPPA, and maintain confidential information

Required Minimum License(s) and Certification(s)

Certified Health Coach Required

Additional Licenses and Certifications

National Board-Certified Health and Wellness Coach. Preferred