Diabetes Community Health Coordinator

Apr 08, 2021
May 13, 2021
Full Time
The Diabetes Community Health Coordinator will work as a member of the multidisciplinary diabetes team with the goal of improving diabetes care for children and adolescents with diabetes. The goal for the Health Coordinator is to develop longitudinal relationships with youth and families in need of additional support. The role consists of two major components. The first component involves patient outreach and coordination of care. The Health Coordinator will assist in contacting patients and families to ensure that follow up appointments are made and attended and that patients have all necessary diabetes medications and supplies. The Health Coordinator will identify any patient needs and connect them with resources or the appropriate team member for further care. The second component involves health coaching in which the Health Coordinator will directly support the patient and their family in meeting diabetes self-care goals and adopting positive self-care behaviors.


Minimum Education
Bachelor's Degree

Specific Requirements and Preferences
Experience in working with patients and health care providers (Required)
Experience in a health care environment and familiarity with case management processes/procedures (Preferred)
Experience with diabetes management (Preferred)

Required Skills/Knowledge
A strong sense of and respect for confidentiality involving both patients/families and fellow employees.
Ability to motivate others towards achieving goals.
Ability to work in a variety of settings with culturally-diverse families and communities with the ability to be culturally sensitive and appropriate.
Ability to work independently with strong sense of focus, task-oriented, nonjudgmental, clear sense of boundaries.
Good interpersonal, oral and written communication skills; ability to establish rapport with youth and families.
Personal or family experience with diabetes preferred.
Spanish speaking preferred

Functional Accountabilities

Diabetes Care Management Outreach
1. Under the direction of the Diabetes Social Work team completes needs assessments, post-discharge questionnaires, care management screenings, and other clinical screening tools.
2. Initiates patient contacts in conjunction with the social work and medical team plan to close gaps of care and discharge follow-up
3. Provides outreach and education to appropriate patients and develops relationships to connect them to needed resources
4. Under the direction of clinical staff (care coordination or clinical practice), locates patients when attempts to contact have failed and initiates contact by visiting home/places of last contact

Documentation and Data Management
2. Facilitate tracking/contact with patients who are identified as high risk or requiring additional support by the Diabetes Team.
5. Documents patient contacts and interventions

Health Coaching
1. Establishes goals for diabetes self-care behaviors with patients and family members and provides health coaching to assist patients in achieving these management goals.
2. Meets with Diabetes Psychologist weekly to review progress with health coaching and engage in additional learning related to supporting youth and families.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
1. Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication 1. Demonstrate collaborative and respectful behavior
2. Partner with all team members to achieve goals
3. Receptive to others' ideas and opinions
Performance Improvement/Problem-solving 1. Contribute to a positive work environment
2. Demonstrate flexibility and willingness to change
3. Identify opportunities to improve clinical and administrative processes
4. Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility 1. Use resources efficiently
2. Search for less costly ways of doing things
Safety 1. Speak up when team members appear to exhibit unsafe behavior or performance
2. Continuously validate and verify information needed for decision making or documentation
3. Stop in the face of uncertainty and takes time to resolve the situation
4. Demonstrate accurate, clear and timely verbal and written communication
5. Actively promote safety for patients, families, visitors and co-workers
6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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