The Diabetes Nurse (DN) will support the Health Care Teams and Primary Care Practitioners in the medical office in order to drive quality around diabetes care and outcomes. The DN serves members in a compassionate, personalized and supportive manner while performing diabetes clinical assessments, education and care coordination on a one-on-one and group basis. The DN completes diabetes focused assessments, creates customized care plans in collaboration with the PCP, member and provides comprehensive diabetes education, identifies, communicates, and rectifies suboptimal diabetes care, and optimizes diabetes related outcomes. The DN supports the development of standard operating procedures, patient care guidelines, educational initiatives, care gaps closure and insulin initiation of identified members with diabetes. He / she assists the member in gaining the knowledge, skills, attitude, and self-awareness necessary to effectively manage his/her diabetes as evidenced by improvement in targeted quality metrics (A1C, LDL, BP, etc.) to help prevent/minimize the complications of diabetes.
Essential Functions:
- Educates member on topics related to diabetes and the disease process; including all aspects of effective self-management (medication, diet and nutritional monitoring; foot care, prevention and care of complications; recommended screenings, blood glucose monitoring and the techniques of self monitoring and insulin injections).
- Utilizes treat to target recommendations per protocol for oral medication and/or insulin and provides clinical patient education, support and follow-up to members to ensure effective self-management.
- Assesses, monitors and implements treatment plans for patients at various stages of the disease. Makes recommendations to the PCP and patient/family for adjustments in the plan of care as required.
- Identifies and helps close care gaps related to A1C, lipid panel, blood pressure, laboratory tests, PCP visits, eye exams, foot exams, flu shots, etc.
- Conducts outreach via letter, secure e-mail, and telephone to targeted members.
- Helps coordinate next care steps including assistance with scheduling appointments/classes with other resources within KP such as Diabetes Class, registered dietitian, clinical pharmacy specialists, behavioral health, nurse visits and PCP as needed.
- Assesses resources available for education in the module (DVDs, handouts, etc) and recommends the current and most appropriate resources to use. Teaches classes, participates in pilot efforts to improve care as needed.
- Provides in-services/support as a nursing/ clinical practice subject matter expert as needed.
- Maintains and updates professional knowledge and skills in diabetes management- Maintain CDE credential.
- Travel to other offices may occasionally be required.
- May perform other duties as assigned.
Qualifications:
Basic Qualifications:
- Bachelor of Science in Nursing.
- Current RN license in State of Georgia.
- Extensive diabetes experience (2+ years) with the ability to become a Certified Diabetes Educator within 1 year of hire.
- 5 years nursing experience as a registered nurse.
- Excellent diabetes and cardiovascular disease and chronic health conditions clinical knowledge base.
- An equivalent combination of post-graduate diabetes training and experience may be considered.
- Knowledge of adult learning principles.
- Able to assess and interpret relevant lab results.
- Ability to work under protocol to initiate and adjust insulin as needed.
- Ability to work collaboratively with a variety of health care professionals.
- Basic knowledge of Microsoft Office Suite (Excel, Work, PowerPoint) essential.
Preferred Qualifications:
- Current Certified Diabetes Educator (CDE).
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.