Diabetes Educator RN - Cheraw SC

About this Role: 

RN position that leverages powerful data insights to proactively identify and engage members who need support the most. You will design individualized care plans, offer self-management education and coordination of resources that assists members to achieve improved health. Collaborates closely with clinical teams to provide guidance on engagement strategies, focused on improving health status of members. Manages a panel of high-risk members with chronic conditions to provide frequent touchpoints and ensure care gap closure as defined by national standards.



Essential Functions: 

Develops personalized treatment plans using provider care plans and member preferences using a coach approach and the pillars of Lifestyle Medicine
Supports a proactive, multidisciplinary team approach directed toward prevention, education and health promotion
Establishes supportive relationship with members
Assesses member’s educational/clinical/social needs, prioritizing care based on elicited information from the member, Epic, and data analysis
Acts as resource for members
Documents touchpoints and progress into the electronic medical record
Collaborates with the full scope of clinical team members to arrange for further medical treatment when needed
Provides support and tools needed to help members take control of their health
Delivers exceptional member experiences and engaging members in their healthcare journeys
Improves health outcomes and better management of any chronic condition
Lowers healthcare costs while improving outcomes
Consults with other members of the healthcare team to solve problems and seek advice
Works closely with client’s vendors as appropriate to support member’s needs where appropriate
Identifies emergency situations and provides care within legal scope of practice
Maintains member privacy and confidential member information
Participates in outreach/follow-up phone calls and follow-up member visits
Provides condition specific self-care education to client employee enrolled in the various condition management programs
Serves as member advocate
Acts as facilitator of Care Team meetings.
Coaches effectively virtually using video and phone
Collaborates with health center staff to coordinate and promote health and wellness programs
May require other duties as assigned.