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GENERAL PURPOSE OF JOB

The Certified Diabetes Care and Education Specialist (CDCES) works within the Condition Management program. The CDCES is responsible for assessment, planning, and implementation of a customized educational program for Condition Program participants. Strong focus on Diabetes patients, and their co-morbidities, but will include other chronic conditions. Will provide Care Coordination for the multidisciplinary team through consultations and referrals to other health care professionals including Providers, wellness coaches, exercise physiologists, and/or registered dietitians. Integrates patient assessments and health history information to develop a comprehensive, self-management care-plan for patients with chronic conditions. Will outreach to a population of high-risk patients as necessary to provide additional support and guidance to leverage patient engagement. The CDCES will provide education and support to individuals and groups, according to their individual Scopes of Practice.  

KEY RESPONSIBILITIES

• Work to the full scope of practice under CDCES credential to provide evidence-based diabetes self-management education and support (DSMES) services including but not limited to blood glucose monitoring, medication management, meal planning, diabetes technology, proper insulin storage and administration, and management of specialist appointments, and lifestyle change.  
• Creating individualized care plans for people with diabetes that consider their lifestyle, goals, beliefs, culture, and needs.
• The CDCES may also titrate and adjust insulin doses and complete diabetic foot exams
• Develop and implement engaging group education classes, cooking demonstrations and activities related to diabetes prevention and management
• Empower patients to better understand and self-manage their conditions through evidence-based education, training and other clinically based activities
• Engage with patients regularly with a focus on behavioral goal setting and member centered support planning.  Makes referrals and connects patients with available resources offered through the clinic, employer sponsored benefits and community.
• Collects participant assessment data in a collaborative and ongoing manner; conduct follow up assessments
• Collaboratively develops individualized care plans, educational goals, learning objectives and a plan for educational content and teaching methods to help patients learn the self-management techniques and behaviors to manage their conditions  
• Evaluates effectiveness of educational services provided by measuring attainment of learning objectives
• Documents assessment data, educational plan, educational services provided and evaluation results in each participant’s Electronic Medical Record  
• Utilizes a team approach to provide patient centered services and ongoing communication
• Identifies when a program participant’s needs are outside the scope of the instructor’s practice and expertise, arranges for additional services to meet needs  
• Acknowledges patient’s rights on confidentiality issues, maintains patient confidentiality at all times, and follows HIPAA guidelines and regulations.
• Completes all documentation accurately, timely and efficiently for regulatory compliance.  Demonstrates skills necessary for proper documentation in the Electronic Medical Record. Participate in quality improvement, continuing education, and other patient care programs established by the health center requirements for QuadMed and/or assigned client groups.

JOB REQUIREMENTS

Education:  

• Graduate from an accredited Registered Nursing program, BSN preferred  

Experience:  

• Minimum two (2) years' experience in direct care of patients with diabetes, experience in ambulatory care preferred
• Insulin pump experience preferred
• Additional experience in any of the following is preferred: management of patients with chronic conditions, including but not limited to COPD, asthma, and/or hypertension

Certificates, Licenses, Registrations: 

• Certified Diabetes Care and Education Specialist certification  
• Current and valid license in the state of the position or compact state license  
• Current CPR (BLS) certification or must be obtained within 60 days of hire

Knowledge, Skills & Abilities: 

• Strong nursing and interpersonal skills
• Able to lead and effectively manage individual and group education sessions  
• Strong skills in utilizing technology (use of Internet and email)
• Strong communication (verbal and written) skills  
• Work independently, self-motivated  
• Skilled in assessment, evaluation, nursing diagnosis, and treatment planning  
• Ability to effectively communicate across all levels of the care team and organization  
• Bilingual a plus
• Proven ability to work successfully with diverse populations and demonstrated commitment to promote and enhance diversity and inclusion