Reporting to the Manager of Health and Wellness, the Bilingual Senior Health & Wellness Nurse is a senior-level clinical leader responsible for overseeing, training, mentoring, and executing the wellness and disease management, programs for Pinnacle Claims Management Inc. (PCMI). This role requires advanced expertise and plays a key role in promoting clinical excellence. In addition to administrative and clinical oversight, this position provides direct health coaching to members, leveraging evidence-based strategies to empower behavior change and improve self-management of chronic and preventive conditions. The nurse will coach and guide members in managing hypertension, diabetes, hyperlipidemia, asthma, pregnancy, weight loss, anxiety and depression, and nicotine cessation. Coaching will incorporate motivational interviewing, goal setting, and personalized care planning to support sustained lifestyle improvements and improved quality of life.

Qualifications

• Bachelor’s degree (or equivalent) and three (3) to five (5) years of experience in health management programs, preferably within a Third-Party Administrator (TPA) health plan or corporate environment, preferred.
• Current RN licensure, required.
• Certified Health Coach credential, preferred.
• Excellent oral and written communication skills in English and Spanish, required.
• Skilled in motivational interviewing, behavior change models, and goal-setting techniques to support member engagement and sustained lifestyle improvements.
• Strong knowledge of HIPAA, and other relevant regulatory and accreditation standards related to care management and patient privacy.
• Proven ability to lead and mentor clinical and non-clinical staff and quality improvement initiatives.
• Experience delivering care management and coaching via virtual platforms, with a high level of comfort in remote work and in person environments.
• Ability to assess member needs using evidence-based guidelines and develop individualized care plans that address both clinical and psychosocial factors.
• Familiarity with population health management principles and strategies to identify high-risk members and reduce preventable healthcare utilization.
• Capacity to manage multiple priorities, meet deadlines, and work both independently and collaboratively in a fast-paced environment.
• Strong critical thinking, clinical documentation, and decision-making skills.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site.
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 25% of time.

Duties And Responsibilities

• Coach and support members in managing chronic and preventive health concerns including hypertension, diabetes, hyperlipidemia, asthma, pregnancy, weight loss, anxiety/depression, and tobacco cessation.
• Provide clinical guidance and oversight of the department’s care management activities.
• Act as a clinical subject matter expert and a point of contact on matters of clinical content.
• Provide clinical expertise to Product Development in the development of applications and tools.
• Act as a client facing clinical and health subject expert and clinical point of contact.
• Conduct telephonic or virtual assessments with members to evaluate clinical needs, readiness to change, and barriers to care.
• Create and manage individualized care plans based on evidence-based guidelines and member input.
• Track, document, and report member outcomes and program performance using electronic health record systems and internal databases.
• Collaborate with interdisciplinary teams to ensure coordinated care.
• Support program development and quality improvement initiatives related to care management and coaching.
• Maintain up-to-date knowledge of clinical guidelines, care management trends and coaching techniques through continuing education.
• Participate in training and mentorship of new clinical staff and health coaches to ensure adherence to best practices.

• Oversee development of tactical and strategic products, services and/or programs for Health Management to support department’s goals.
• Monitor business needs. Create, develop, enhance and document processes and procedures.
• Develop, coordinate, manage and maintain the health management programs to reduce health risk, medical costs and encourage healthy lifestyles.
• Maintain records of patient-related phone conversations participating in the health management program.
• Provide education to the staff and assigned Health Management cases and conduct follow-up calls.

• Track and document member progress toward clinical goals using evidence-based health coaching frameworks.
• Maintain accurate, timely, and comprehensive records of all coaching interactions, care plans, and outcome measures.
• Collect and analyze health metrics (e.g., blood pressure, weight, HbA1c) to demonstrate improvements in clinical outcomes over time.
• Collaborate with the Health and Wellness Manager to evaluate and develop coaching programs that address the evolving needs and goals of member populations.
• Generate reports and dashboards to visualize member outcomes, engagement trends, and coaching effectiveness.
• Ensure documentation aligns with compliance, quality, and program evaluation standards for healthcare interventions.

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a valid Registered Nurse’s License.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet. 
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• Maintain a clean DMV record and the ability to travel to locations throughout the US (mainly California and Arizona) up to 25% of time.
• Other duties as assigned.

Physical Demands/Work Environment