Annual Wellness Visit Nurse - Marshall Family Medicine

Marshall Health•Barboursville, WV

About The Position

The Annual Wellness Visit Nurse conducts detailed health assessments, including reviewing medical histories, evaluating current health conditions, and identifying potential health risks. The nurse helps identify patients who may benefit from integrated care management or care coordination services and provides education on preventive health practices, lifestyle modifications, and chronic disease management. The role provides ongoing support, evaluates progress toward patients’ health goals, and revises care plans in collaboration with patients and the healthcare team. The nurse documents patient information—including vital signs, health histories, and screening results—in electronic medical records and completes documentation in a timely manner. The role also assesses risks and recommends preventive care and follow-up actions; collaborates with physicians, nurse practitioners, and other team members on individualized care plans; and helps coordinate referrals, appointments, screenings, and tests. The nurse advocates for patients, supports their engagement in their health and wellness, and ensures activities comply with applicable laws, regulations, and organizational policy. Other duties may be assigned or requested.

Responsibilities

Conduct detailed annual wellness health assessments, including reviewing medical histories, evaluating current health conditions, and identifying potential health risks.
Help identify patients who may benefit from integrated care management or care coordination services.
Educate patients about preventive health practices, lifestyle modifications, chronic disease management, and their specific conditions and needs.
Provide ongoing support and evaluate progress toward stated health goals; revise healthcare plans as needed with patients and the healthcare team.
Document patient information, including vital signs, health histories, and screening results, in electronic medical records, and complete documentation in a timely manner.
Assess potential health risks based on patient data and recommend preventive care and follow-up actions.
Collaborate with physicians, nurse practitioners, and other healthcare team members to develop and implement individualized care plans.
Participate in regular team and organizational meetings.
Assist in orienting new personnel on quality improvement and population health.
Promote a collaborative atmosphere across the organization.
Collaborate with the RN Quality Manager to improve quality metrics and care coordination and to assist with enrollment and support of care management programs.
Coordinate referrals, follow-up appointments, and additional screenings or tests as necessary.
Advocate for patients and help them obtain their maximum level of health.
Foster a supportive environment that encourages patients to take an active role in their health and wellness.
Ensure activities comply with applicable laws, regulations, and organizational policy.
Perform other duties as assigned or requested.