Registered Nurse (RN) Care Management Diabetes Educator

Department:

39743 Advocate Aurora Health Corporate - APP: AdvocateCare O/P Care Management Division

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Hours M-F 0800-5pm - Remote - for WI patients

Required CDE certification and WI RN licensure

Pay Range

$34.90 - $52.35

MAJOR RESPONSIBILITIES

• Outreaches to and manages a caseload of patients identified through referrals/consults and/or population stratification algorithms per department expectations. Interacts with patients primarily through telephonic and/or virtual means. In-person care opportunities are addressed on a case-by-case basis. 
• Executes nursing process that starts with assessing whole person needs which influence patient outcomes, including (but not limited to): social determinants of health, medication use/adherence, self-management knowledge/skills/abilities, patient-centered goals, and physical symptoms.
• Utilizes clinical expertise, American Diabetes Association standards, and evidence-based practice to identify and analyze complex problems in nursing care of individuals and populations with diabetes; makes recommendations, evaluates alternative solutions, and follows-up with appropriate health care personnel and patients. May adjust diabetes medications from physician-prescribed starting dosage per protocol (with appropriate training/competence) and evaluate effects. Advocates for patients and professionally communicates with leaders and interprofessional team to create a patient-centered plan of care to support optimal patient and population well-being.
•  Uses approved technology to interact with patients with diabetes, their equipment, and related data. Technology utilized includes (but is not limited to): soft phone, glucometer, continuous glucose monitor, insulin pump, glucometer data platforms, remote patient monitoring, and video visit software.
• Executes workflows within the electronic medical record and related patient-care platforms per department standards. Documents according to department and professional standards set by American Diabetes Association.
• Communicates and collaborates with interprofessional, cross-continuum team including the primary care team, endocrinologist, hospital care team, care managers, inpatient case managers, pharmacists, social work, community health workers, and other care partners to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services.
• Understands value-based care delivery concepts and related contractual obligations and quality performance metrics, and cost-savings objectives. Connects process and outcomes data with personal and department successes and opportunities.
• Functions as an expert resource within department to support continuous learning, high reliability, quality improvement, patient engagement, maximization of technology, and internal teammate skills and knowledge around caring for patients and populations with diabetes.
• Acts as a representative of and liaison to Ambulatory Care Management. Engages in professional interactions that foster collaboration and awareness of care and services within Ambulatory Care Management.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.  Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.  Age-specific information is developed further in the departmental job standards.

License/Registration/Certification:  

• Registered Nurse license issued by the state in which the team member practices, and - WI RN licensure needed at time of application
• Registered Certified Diabetes Educator (C.D.E.) by the American Association of Diabetes Educators or eligibility to take Board exam is required. Must obtain C.D.E within 6 months of start date if not certified at time of hire. Assumes responsibility for maintaining certification.

Level of Education:   Bachelor's Degree in Nursing

Years of Experience:  Requires 5 years in patient care, focusing on chronic illness working as a certified d