Registered Nurse Care Manager - Direct Primary Care+ (Holland based)

Job Description

Job Description

Job Title: Registered Nurse Care Manager – Direct Primary Care

Company Overview

At Exponential Health, we believe that a personal, proactive approach to healthcare should be the norm. We are redefining medicine by focusing on each Member's unique needs and investing in their long-term health. Our mission centers on preventative medicine, delivering definitive results, and transforming the traditional reactive healthcare model into one that prioritizes prevention and optimal health.

The Exponential Health Difference

At Exponential Health, our culture is built on a foundation of innovation, collaboration, and a deep commitment to preventive care. We are a forward-thinking organization that embraces a new model of healthcare, encouraging our team to actively contribute innovative ideas that enhance both our operations and the services we provide to our Members.

Innovation: We embrace a new healthcare model, encouraging our team to actively contribute ideas that enhance member experiences and services.

Personalized Care: We prioritize building strong relationships with our Members, ensuring high-touch, tailored care that meets their individual needs.

Health Education: We empower Members to take charge of their health through education, coaching, and lifestyle modification support.

Collaboration: Our providers, nurses, specialists, and care teams work together to ensure seamless coordination of care and an exceptional member experience.

Continuous Improvement: We remain committed to staying current on healthcare best practices, ensuring our Members receive the highest standard of preventive and proactive care.

At Exponential Health, we are not simply providing healthcare—we are investing in a holistic, proactive, and member-centered experience that nurtures lasting relationships and drives optimal health outcomes.

Job Summary

The Registered Nurse Care Manager serves as a key member of the Direct Primary Care team, providing high-touch care coordination, chronic disease management, preventive health support, and member advocacy for a defined patient population.

The RN Care Manager develops trusted relationships with Members, proactively identifies health risks, supports care plan implementation, and serves as a central point of contact throughout the healthcare journey. This role focuses on improving health outcomes, enhancing member engagement, reducing avoidable healthcare utilization, and supporting employer-sponsored population health initiatives.

The RN Care Manager works closely with physicians, advanced practice providers, specialists, employers, and community resources to ensure Members receive coordinated, timely, and cost-effective care.

Duties and Responsibilities

Care Management & Coordination

• Develop and maintain individualized care plans for Members with chronic and complex health conditions.
• Coordinate care transitions following hospitalizations, emergency department visits, specialist consultations, and other healthcare encounters.
• Monitor patient progress toward health goals and proactively intervene when barriers or risks are identified.
• Ensure timely completion of recommended screenings, preventive services, and follow-up care.

Chronic Disease Management

• Provide ongoing support and education for Members managing conditions such as diabetes, hypertension, obesity, cardiovascular disease, and behavioral health concerns.
• Conduct regular outreach and follow-up to promote treatment adherence and improve health outcomes.
• Utilize evidence-based guidelines to support chronic disease management and preventive care initiatives.

Member Engagement

• Build meaningful relationships with Members through active listening, empathy, curiosity, and personalized support.
• Serve as a trusted resource for Members navigating healthcare decisions and treatment plans.
• Deliver high-touch service that enhances member satisfaction, engagement, and retention.
• Encourage lifestyle modifications and healthy behaviors through coaching and education.

Population Health Management

• Identify high-risk Members through risk stratification and health assessment data.
• Implement proactive outreach programs designed to improve outcomes and reduce avoidable healthcare costs.
• Support employer-sponsored wellness and population health initiatives.
• Monitor quality metrics and member engagement measures to support organizational goals.

Care Navigation

• Assist Members in navigating the healthcare system, including referrals, specialist appointments, diagnostic testing, and community resources.
• Collaborate with healthcare providers to ensure seamless communication and continuity of care.
• Help Members understand treatment recommendations, medication plans, and healthcare resources.

Communication

• Provide timely communication through phone, secure messaging, telehealth, and in-person interactions.
• Respond promptly to Member concerns and clinical questions within established protocols.
• Facilitate communication among providers, specialists, employers, and Members to ensure coordinated care.

Documentation & Clinical Support

• Maintain accurate and timely documentation within the electronic medical record.
• Track patient outcomes, interventions, and care management activities.
• Support providers with care coordination activities and population health initiatives.
• Participate in quality improvement projects and workflow development.

Business & Program Development

• Identify opportunities to enhance member experience, care delivery, and operational efficiency.
• Contribute ideas that support the continued growth and innovation of Exponential Health's Direct Primary Care model.

Required Skills and Abilities

• Strong clinical knowledge of chronic disease management, preventive medicine, and population health principles.
• Exceptional interpersonal and communication skills with a commitment to delivering an outstanding member experience.
• Ability to build trusted relationships and engage Members in their health journey.
• Strong organizational skills with the ability to manage multiple priorities and a diverse patient population.
• Experience utilizing EMR systems.
• Comfortable utilizing telehealth and digital communication platforms.
• Strong problem-solving and critical-thinking skills.
• Passion for innovative healthcare delivery and proactive wellness strategies.
• Commitment to improving healthcare quality while reducing unnecessary healthcare utilization and spending.

Education and Experience

Required

• Active Registered Nurse (RN) license in the State of Michigan.
• Bachelor of Science in Nursing (BSN) preferred.
• Minimum of 3 years of nursing experience.

Preferred

• Experience in primary care, care management, case management, population health, direct primary care, concierge medicine, occupational health, employer-sponsored health clinics, or value-based care environments.
• Certification in Care Management (CCM), Ambulatory Care Nursing (RN-BC), or similar certification preferred.
• Experience working with chronic disease management programs and preventive health initiatives.

Physical Requirements

• Ability to sit or stand for prolonged periods.
• Ability to travel periodically between Grand Rapids and Holland office locations as needed.
• Ability to utilize computers, telephones, and digital communication platforms throughout the workday.

Success in This Role Will Be Measured By

• Member engagement and satisfaction
• Accessibility and responsiveness to Members
• Improvement in chronic disease outcomes
• Completion of preventive care measures
• Reduction in avoidable emergency department visits and hospitalizations
• Successful care transitions and follow-up completion
• Contribution to employer population health initiatives
• Overall Member retention and experience

This version positions the RN as the "quarterback" of the Direct Primary Care model, which aligns well with Exponential Health's employer-health strategy, population health goals, and concierge-style member experience.