OverviewProvides education and coordination of care to patients who have been diagnosed with Diabetes. Develops care initiatives toassess and coordinate diabetes care management with the goal of achieving self-management skills related to Diabetes.
Responsibilities1. Participates in the assessment of patient's physical, emotional and social needs.2. In collaboration with the PCP develops and assumes responsibility for care planning.
3. Assists patient with the development of their short and long term goals.4. Provides diabetes education, interactively and collaboratively with patient and care team.
5. Tracks and ensures appropriate follow up care.6. Maintains communication with the patient, their family, and the care team to monitor and refi ne treatment plan.
7. Participates in audits, medical record reviews, surveys and studies. Documents in the EMR (electronic medical record).
8. Utilizes resources to assist with identifi cation of diabetic patients who are in poor control of their diabetes. Identifi es gaps in care byutilizing the diabetic registry.
9. Attends and participates in staff meetings, care coordinator meetings, divisional meetings, and weekly case conferences.
Serves asan active participant in the Diabetes recognition program.10. Assists patients in the development of annual goals and the identifi cation of outcomes for continuous quality improvement.
11. Maintains knowledge on new guidelines and medications.12. Performs other duties as required or assigned.Qualifications Graduate from an accredited Nursing Program required.
Associate Degree (ADN) prepared nurses with 5 years of clinical nursing experience and experience with diabetes education orcounseling (glucose meter) required.
Bachelor of Science Degree in Nursing (BSN) preferred. Strong organizational skills, excellent verbal, written and communication skills required.
Must possess sound decision-making, time management and negotiating skills. Excellent computer skills are required. Demonstrated ability and interest in the care of individuals with chronic disease.
CDE strongly preferred or must complete CDE certifi cation program within 3 years in the position.Required Licensure / Certifications Licensed Registered Nurse with NH eligibility.
Basic Life Support (BLS) Certifi cate required.
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