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Chronic Condition Manager - Ardmore, OK (40 hours Weekly with Benefits and PTO)

Everside Health

Everside Health

Accounting & Finance
Ardmore, OK, USA
Posted on Friday, July 21, 2023


Facilitate, develop, monitor, measure, and report on wellness and chronic disease prevention and management programs that complement the Health Center maintained and coordinated by Everside Health. The Chronic Condition Manager will educate, counsel, and coach patients on how to prevent and/or manage chronic disease in face-to- face, virtual and/or telephonic formats, as well as in one-on-one and/or group settings. He or she may also be responsible for developing educational materials. The Chronic Condition Manager may be asked to coordinate efforts among all client vendors to provide cohesiveness of services and to better engage the client population. These duties are carried out for a specific client at its various locations


  • Facilitates chronic condition management and prevention programs, including but not limited to: Diabetes Management, Diabetes Prevention, Hypertension Management, Hyperlipidemia Management, COPD, Asthma, Obesity and Cardiovascular Disease. Programs include clinical, educational, and health coaching components
  • Develops individualized interventions designed to improve and maximize health outcomes
  • Conducts thorough and objective evaluations of the patients’ status, including psychosocial, physical, financial, and educational needs, prognosis, and past and present treatment course and services
  • Identifies and enrolls individuals that qualify for chronic condition management programs
  • Establishes supportive and confidential relationships with patients
  • Assesses patients’ clinical and educational knowledge of chronic condition, readiness to change behavior and individualizes program/s based on needs
  • Collaborates with other members of the healthcare team to optimize care and solve problems
  • Conducts outreach via phone, email and regular mail
  • Provides face-to-face, virtual and telephonic lifestyle and behavior-related health coaching in both individual and group settings
  • Reviews HRA results, if applicable, and provides education and counseling to patients based on risk factors
  • Follows workflow and policy guidelines for documentation in the electronic medical record, including the utilization of predictive modeling and behavior change analytics tools
  • Applies critical thinking skills and problem-solving techniques to the condition management process
  • Participates in the analysis of available data, review of reports, and strategy for enrollment of members to condition management programs
  • Performs in-person, virtual, telephonic, and/or electronic proactive outreach to members that are eligible for disease management programs, as well as to unengaged members
  • Participates in education sessions coordinated by Everside clients for their respective, eligible patient population
  • Coordinates efforts with other vendors (carriers, EAP, etc.) to inform client population of all available resources
  • Communicates with Everside Corporate and/or carrier to provide compliance-related information and necessary documentation
  • Refers to onsite providers, primary care physicians, and/or specialists, as needed
  • Contributes to and maintains the Everside database to stay current on new, innovative techniques to promote health, wellness, and chronic disease prevention and management
  • Maintains current knowledge of disease processes, available resources, and treatment options appropriate to patient populations.
  • Performs other duties as assigned


  • Master’s degree from an accredited institution in Nutrition, Exercise Science, Health Education, or other allied health field plus a minimum of 3 years’ experience in developing, monitoring, conducting, and reporting on chronic condition management programs.


  • Registered Nurse (RN) or Bachelor’s degree in Nursing (BSN) plus a minimum 3 years experience in chronic disease management.
  • Certified Diabetes Care and Education Specialist (CDCES), Registered Dietitian Nutritionist (RDN), American College of Sports Medicine Clinical Exercise Physiologist or Registered Clinical Exercise Physiologist (ACSM-CEP), Master Certified Health Education Specialist (MCHES) strongly preferred.


  • Experience leading and developing presentations. High energy personal style and aptitude for process-oriented thinking
  • Track record of consistent, stable employment along with the ability to work independently and as a part of a team
  • Demonstrated passion for health and wellness
  • Demonstrated proficiency in use of Microsoft Office products
  • Demonstrated competence in multi-tasking
  • Excellent critical thinking skills

Pay Range: $75,000 - $90,000/yr

The actual offer may vary dependent upon geographic location and the candidate’s years of experience and/or skill level.

Everside Benefits Summary

We believe in empowering teammates to do their best work and build better healthcare. Below are some of our benefit offerings. Eligibility is based on 24/hr week.

  • Health and Well-Being: Free Everside membership for in person and virtual care, employer paid life and disability insurance, and choice in medical/dental plans, vision, employer funded HSA, FSA, and voluntary illness, accident and hospitalization plans. Benefits are effective on the first of the month following date of hire.
  • Financial Support: Competitive compensation, 401k match, access to financial coaching through our Employee Assistance Program
  • Lifestyle: Paid time off for vacation, sick leave, and more, holiday schedule

Learn more at https://www.eversidehealth.com/careers/