ProviDRs Care (PCN)
Job Description: RN Wellness Program Coordinator / Case Manager
Department: Integrated Health Management (IHM)
Reports To: RN Supervisor, Integrated Health Management
Employment Status: Full-Time
Work Location: On-Site
FLSA Classification: Non-Exempt
Work Hours: 8a – 5p or 10a – 7p, Monday through Friday
THIS POSITION IS AN ON-SITE JOB IN AN OFFICE SETTING.
Position Summary
The RN Wellness Program Coordinator / Case Manager is responsible for the day-to-day clinical coordination, member education, and operational support of Unified Health Plan's (UHP) wellness program.
The program encompasses biometric screenings, wellness incentives, weight management, preventive health activities, chronic disease management, and individualized health education.
The RN serves as the primary nursing contact for enrolled members and the designated clinical liaison between UHP and the contracted wellness program vendor. This position is responsible for helping members understand available wellness services, interpreting screening results within the RN scope of practice, identifying health risks, establishing individualized wellness goals, and supporting ongoing participation.
The RN independently coordinates the clinical activities of the wellness program with assistance from Care Navigators (CNs) and oversight and support from the RN Supervisor.
The position also performs traditional case management duties as assigned, based on program enrollment, member acuity, and departmental needs.
Essential Duties and Responsibilities
1. Wellness Program Coordination
- Serve as the designated RN responsible for the daily clinical coordination of UHP's wellness program.
- Function as the primary clinical point of contact for the contracted wellness program vendor.
- Become proficient in the wellness program's enrollment requirements, services, screening processes, incentive structure, reporting capabilities, and participation guidelines.
- Coordinate member enrollment, education, engagement, and follow-up activities.
- Monitor participation trends and identify barriers to member engagement.
- Collaborate with the wellness vendor and internal departments to resolve member-related operational issues.
- Participate in program implementation, workflow development, and continuous improvement initiatives.
- Provide routine program updates and performance reports to the RN Supervisor and IHM leadership.
2. Biometric Screening Coordination and Follow-Up
- Educate members regarding biometric screenings and the importance of understanding their health measurements.
- Review available biometric screening results, including blood pressure, blood glucose, hemoglobin A1c, cholesterol, body mass index, and other program-specific measurements.
- Identify abnormal or high-risk screening results requiring additional education, provider follow-up, or clinical intervention.
- Contact members with identified health risks according to established outreach protocols.
- Explain screening results in understandable terms without independently diagnosing medical conditions.
- Encourage appropriate follow-up with primary care providers and specialists.
- Coordinate referrals to case management, chronic disease management, or other available resources when indicated.
- Document member education, outreach, identified risks, and recommended follow-up.
- Monitor completion of recommended follow-up activities when information is available.
- Escalate urgent or potentially serious clinical findings according to established protocols.
3. Wellness Incentive Education and Support
- Educate members regarding available wellness incentives, eligibility requirements, participation activities, and completion deadlines.
- Explain the steps necessary to participate in and complete incentive-related activities.
- Assist members in understanding program requirements and resolving participation questions.
- Coordinate with the wellness vendor and appropriate internal departments to address discrepancies involving reported activity completion or incentive eligibility.
- Monitor participation and identify opportunities to improve member understanding and completion rates.
- Maintain accurate documentation of incentive-related education and assistance.
- Refer formal incentive disputes, eligibility determinations, and benefit interpretation questions to the appropriate responsible department or vendor.
- Follow applicable privacy, nondiscrimination, and wellness program compliance requirements.
4. Weight Management and Lifestyle Education
- Provide individualized education and support for members participating in weight management activities.
- Educate members on nutrition, physical activity, behavioral modifications, and sustainable lifestyle changes.
- Assist members in establishing realistic, measurable weight management and health improvement goals.
- Identify barriers to lifestyle changes and provide appropriate education, resources, and encouragement.
- Monitor member-reported progress and reinforce individualized wellness goals.
- Coordinate with primary care providers, registered dietitians, behavioral health professionals, and other appropriate resources.
- Identify members who may benefit from additional clinical evaluation or case management services.
- Provide nonjudgmental, evidence-based education that promotes overall health rather than focusing solely on weight reduction.
5. Preventive Health and Chronic Disease Education
- Educate members regarding age-appropriate preventive screenings, immunizations, and routine healthcare visits.
- Encourage completion of recommended preventive services based on current clinical guidelines and individual risk factors.
- Identify potential preventive care gaps using available health information.
- Coordinate with Care Navigators to assist members with locating providers and scheduling preventive services.
- Provide education regarding diabetes, hypertension, cardiovascular disease, obesity, and other prevalent chronic conditions.
- Reinforce the importance of medication adherence, routine monitoring, and ongoing provider follow-up.
- Identify members requiring additional clinical support, care coordination, or referral to case management.
- Collaborate with providers and other healthcare professionals to support continuity of care.
6. Member Engagement and Health Coaching
- Serve as the primary nursing contact for wellness program participants.
- Conduct individualized nursing assessments to identify health risks, educational needs, readiness for change, and barriers to participation.
- Develop member-centered wellness goals and appropriate follow-up plans.
- Utilize motivational interviewing, active listening, and evidence-based health coaching techniques.
- Provide ongoing member education, encouragement, and support through telephone or other approved communication methods.
- Monitor member participation and progress toward established goals.
- Identify members requiring additional clinical evaluation or intervention.
- Promote member independence, informed decision-making, and self-management of health conditions.
7. Wellness Vendor Liaison Responsibilities
- Maintain regular communication with the contracted wellness program vendor.
- Coordinate resolution of member concerns, enrollment issues, screening follow-up questions, and program participation discrepancies.
- Review available vendor reports for enrollment, screening completion, engagement, incentive participation, and wellness outcomes.
- Identify reporting discrepancies, communication gaps, and operational concerns.
- Participate in vendor meetings and provide clinical input regarding program improvements.
- Escalate unresolved vendor issues and contractual concerns to the RN Supervisor.
- Ensure appropriate handling and sharing of protected health information in accordance with HIPAA and applicable program requirements.
8. Collaboration With Care Navigators
- Coordinate with Care Navigators to support member outreach, appointment scheduling, referrals, and administrative follow-up.
- Assign appropriate nonclinical navigation activities within established departmental workflows.
- Provide nursing guidance when Care Navigators identify clinical questions or concerns.
- Ensure nursing assessments, clinical interpretation, and clinical decision-making are completed by appropriately licensed personnel.
- Monitor completion of assigned navigation activities.
- Communicate workflow concerns or resource needs to the RN Supervisor.
9. Case Management Responsibilities
- Perform case management duties as assigned based on departmental priorities and workload.
- Complete comprehensive nursing assessments and individualized care plans.
- Coordinate medical services and facilitate communication among members, providers, and healthcare partners.
- Support members with chronic illnesses, complex healthcare needs, and transitions of care.
- Identify barriers to treatment adherence and access to healthcare services.
- Provide education regarding diagnoses, treatment plans, medications, and available healthcare resources.
- Identify high-risk and high-cost members requiring additional intervention.
- Document case management activities according to departmental policies and established timeframes.
- Maintain appropriate case management productivity while prioritizing assigned wellness program responsibilities.
10. Documentation, Reporting, and Quality Improvement
- Document member contacts, assessments, education, screening follow-up, referrals, and interventions accurately and timely.
- Maintain member information in designated clinical documentation systems.
- Prepare reports and communicate findings to the RN Supervisor.
- Participate in quality improvement initiatives and departmental audits.
- Assist in the development of educational materials, clinical workflows, and program procedures.
- Maintain compliance with organizational policies, applicable regulations, and confidentiality requirements.
Supervisory Responsibilities
This position has no direct personnel management responsibilities.
The RN provides clinical guidance and coordinates assigned wellness program activities with Care Navigators. The RN Supervisor retains responsibility for staff supervision, performance management, workload oversight, and clinical escalation support.
Work Environment
- Office-based with frequent telephone and electronic communication.
- Requires regular interaction with members, providers, external vendors, and internal departments.
- Must be able to independently manage daily responsibilities and respond to changing program needs.
- Requires flexibility to perform additional case management duties when assigned.
Disclaimer
This job description outlines the general responsibilities of the position and may be modified based on organizational needs, contractual requirements, and applicable regulations.
Equal Employment Opportunity
ProviDRs Care is committed to equal employment opportunity and provides employment opportunities without regard to legally protected characteristics, in accordance with applicable federal, state, and local laws.
Requirements
Education
- Graduate of an accredited nursing program.
- Bachelor of Science in Nursing required.
Licensure
- Current, unrestricted RN license in Kansas or a recognized multistate compact license.
Experience
- Minimum three years of clinical nursing experience.
- Experience in wellness, population health, chronic disease management, case management, or care coordination preferred.
- Experience in a TPA, health plan, or managed care setting preferred.
- Experience providing telephonic education, health coaching, or member outreach preferred.
- Experience coordinating with external healthcare vendors preferred.
Required Knowledge, Skills, and Abilities
- Strong nursing assessment and clinical judgment skills.
- Knowledge of biometric screening measures and common cardiometabolic risk factors.
- Understanding of preventive care, weight management, chronic disease management, and health promotion.
- Ability to explain clinical information in understandable terms.
- Strong communication, motivational interviewing, and member engagement skills.
- Ability to independently organize and coordinate a clinical program.
- Strong documentation, reporting, and time-management skills.
- Ability to manage competing priorities and work collaboratively with internal staff and external vendors.
- Knowledge of case management principles and care coordination.
- Understanding of HIPAA, professional nursing standards, and member confidentiality.
- Proficiency with electronic health records, care management platforms, and Microsoft Office applications.
Benefits
Compensation and Benefits
ProviDRs Care offers a competitive compensation and benefits package designed to support the health, financial well-being, and work-life balance of our employees.
Our benefits package may include:
Competitive salary based on qualifications and experience
Comprehensive medical, dental, and vision insurance
Company-sponsored life insurance
Short-term and long-term disability coverage
401(k) retirement savings plan with employer matching
Paid time off (PTO)
Paid company holidays
Supportive, team-oriented work environment
Consistent Monday–Friday work schedule