Salary Range: $24.00 to $26.00 Hourly

Summary:

Under the direct supervision of the Registered Nurse Supervisor, the Disease Management, LVN is responsible for case management of the chronically ill patients, specifically diabetic patients, to include, but not limited to; coordinating, collaboratively monitoring, analyzing, entering/evaluating data managing, nursing care and educating as well as working closely with other nursing staff and providers on case management aspect for diabetic patients. 

DUTIES AND RESPONSIBILITIES:

• Responsible for case management of the chronically ill patients, specifically diabetic patients. 
• Responsible for collecting, and collaboratively screening and evaluating data pertaining to quality of care provided to diabetic patients registered in electronic registry 
• Responsible for providing direct nursing patient care services within scope of practice throughout the five stage life cycle, OB/GYN, pediatrics, adolescent, adult including women health and geriatric medicine at the Agency’s network of Health Center delivery sites. 
• Responsible for following-up on electronic registered patients’ referrals and lab tests as recommended by diabetes clinical guidelines. 
• Responsible for conducting diabetes classes twice weekly and one-on-one diabetic education for diabetic patients as needed. 
• Responsible for providing diabetes health education to patients and documents education in the Patient/Family Education, Electronic Medical Record. 
• Responsible for collaborating with inter-disciplinary teams, e.g., managers, nurses, providers, line staff, and community service staff for the enhancement of patient care. 
• Responsible for assisting with the integration of all the elements of the Chronic Disease Care Model and assisting the Collaborative Team in enforcing the diabetes clinical guidelines and standards. 
• Responsible for data entry and monitoring registered patient data for trending and reporting. 
• Responsible for assisting the Registered Nurse Supervisor on audits pertaining to the PPP Disease Management Program and clinical records review. 
• Responsible for assisting with the implementation of corrective action plans whenever necessary to fulfill compliance goals and objectives in the most efficient manner. 
• Responsible for assisting the Registered Nurse Supervisor with submitting monthly activity reports to the California Primary Care Association, CCALAC, and the PPP Disease Management Program as well as assisting with annual UDS reports. 
• Responsible for adhering to AVFHC’s policies and procedures, governmental and other regulatory agencies guidelines, standards, and criteria, as applicable. 
• Responsible for attending in-services and educational classes to maintain nursing skills competency, and current knowledge for standard of care and effective practice. 
• Responsible for actively participating in the Improving Organization Performance Program, to include The Joint Commission, Patient Care Medical Home, Infection Control Program, Safety Program, and Emergency Preparedness. 
• Responsible for assisting with all other related duties assigned. 
• Responsible for assisting the Registered Nurse Supervisor with other related assignments. 
• Responsible for providing direct patient care and assist providers as needed. 

REQUIREMENTS:

• Graduate from an approved accredited nursing program. 
• Current LVN California State License. 
• Minimum one (1) year clinical or medical-surgical hospital and health education experience. 
• Case Management experience preferred. 
• Bilingual (English/Spanish). Familiarity with the Hispanic culture is preferred. 
• Current CPR certificate.