SDPI and HP DP Coordinator

SUMMARY OF POSITION: The SDPI/HPDP Coordinator provides culturally relevant education on diabetes and prediabetes care and prevention and promotes holistic wellness for the Mi'kmaq community. This is
accomplished through outreach to eligible tribal-member homes, off-site health-care facilities, and on-site. The coordinator serves as a liaison between the Mi’kmaq Health Department, Tribal programs, and the community
to facilitate access to services and improve the quality-of-service delivery, including coordinating services to improve diabetes-related health outcomes.

EDUCATION AND PERTINENT EXPERIENCE): Registered Nurse (RN). The incumbent will possess or be able to pass the Certified Diabetes Care and Education certification or similar certification/licensure within six (6) months of hire and three (3) years of experience promoting and assisting with health prevention education programs, services, functions, and activities. LICENSES OR CERTIFICATIONS: Valid RN or higher licenses. Possess a valid driver's license. Be eligible to be put on the tribe's vehicle insurance policy. SKILLS/KNOWLEDGE/ABILITIES REQUIRED: A highly resourceful team player who can also be effective independently. Creative thinker who actively seeks opportunities and proposes solutions. Strong interpersonal skills, including tact and flexibility to work effectively with supervisor, staff, and participants. Computer skills to include Word, Excel, PowerPoint, and Outlook. Knowledge of Electronic Health Records (EHR) and RPMS is a plus. Possess good communication skills (oral and written). Must be familiar with the cultural factors relative to the care of Native Americans. Facilitate group classes proficiently using a wide range of skills and techniques to help participants understand their common objectives and assist in achieving them. Understand how social determinants of health impact the community and participants. WORKING CONDITIONS: Work is performed in an office and primary care setting, Tribal and community buildings, and patient homes. Work requires long periods of regular and recurring standing, walking, bending, and lifting no more than 50 pounds. Items may be placed in overhead storage. Occasionally, there is exposure to contagious and infectious diseases. The work may require de-escalation strategies with patients, families, and visitors. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. TRAVEL REQUIREMENTS: Willingness to travel throughout Aroostook County to visit eligible tribal members' homes, hospitals, and other appropriate health agencies and Tribal Offices. The ability to travel and attend meetings and trainings throughout the State of Maine, overnight and out of town, both locally & nationally, with minimal frequency. Agency-owned vehicles will be made accessible so the incumbent can achieve assigned duties. However, a reliable, private car is a must.

FUNCTIONS/TASKS: • As a Diabetic nutritionist. Assess patients' nutritional and health needs using documentation in the Electronic Health Record. • Counsel patients on nutrition issues and healthy eatinghabits. • Develop meal and nutrition plans, considering patients' preferences and budgets. • Evaluate and monitor the effects of nutrition plans and practices and make changes as needed. • Is responsible for a wide range of tasks, including but not limited to closing the loop with patients, engaging patients and re-engaging assigned patients, and working as a part of the diabetic care team. The Community Health Coordinator (CHC) may be assigned a minimum client load and home visits per week, as established by the immediate supervisor. • Provide education and support to participants on the SDPI registry by facilitating group classes focused on diabetes management and prevention, hypertension, weight management, healthy eating, stress management, and other chronic diseases via newsletter and other written formats, in-person/virtual workshops, and videos. • Outreach to members who are historically hard to engage or not linked to community services and provide proactive follow-up and monitoring. • Serve as a patient advocate (with patient present) either in person or via telephone for those who need assistance in applying for and the effective utilization of alternate resources such as Medicare, Medicaid, Department of Veteran's Affairs, Bureau of Employment Compensation, Third-Party Liability, Prescription Assistance Plans, etc. • Distributes health care brochures, educational videos, and other health-related and injury prevention materials. Serves as the "backup" for car seats, • Co-coordinates and plansthe annual Health Fair. • Conduct home visits according to division policy and assist in referring clients, according to protocol, who need healthcare and services to the appropriate health resources, i.e., Purchased/Referred Care (PRC), injury prevention, primary care, behavioral health, environmental health, physical wellness, and nutritional educational programs, services, functions, andactivities. • Maintains log of activities, takes meeting minutes, compiles data for reports, creates digital presentations, writes reports, edits, proofreads and performs other information preparation duties. Maintains an accurate record of the program. Prepares and submits written quarterly, semi-annual, and annual reports within specified periods. • Serves as the Special Diabetes Prevention for Indians (SDPI) Diabetes Program Coordinator. Responsible for coordinating, implementing, and evaluating the approved scope of work of the Diabetes Program. • Review, evaluate, and monitor the SDPI program to ensure adherence to funding objectives, including — but not limited to—outreach, registration, wellness activities, data collection, patient education, and reporting; coordinate with the clinical team to provide extensive information on diabetes prevention, care, and management to patients and community groups as requested. • Maintain the RPMS Diabetes Registry with data collection to meet the SDPI program outcome measures and objectives. • Stay current on practices and concepts in health education through current literature, seminars, and direct contact with health professionals. • Participate in proficiency/competency testing events as assigned. With the program director's approval, advance job knowledge and skills through continuing education efforts. • Assisting with clinic operations, patient intake, lab draws, injections per protocol, and patient triaging according to clinic needs and current best practices. • Reports to the immediate supervisor any significant or abnormal findings related to health and social matters that come to incumbents' attention during the performance of their duties. • Attend staff and other meetings, in-services, and other events as directed by the supervisor. o Reports to work, meetings, training, and scheduled appointments on time. • Attends in-service and out-of-area workshops and training sessions pertinent to assigned duties. • Maintains strict compliance withclients' EHR documentation policies. • Reviews, signs, and maintains strict adherence to the Privacy Act of 1974 and Confidentiality Statement Reviews and adheres to Health Insurance Portability and Accountability Act (HIPAA) rules andregulations. • Review Mi’kmaq Nation/ Mi’kmaq Health Department Personnel and Fiscal Policies and conduct activities in accordance with those established policies. • All other duties as assigned by supervisor. EVALUATION Feedback will be practiced continuously, and the notes will be attached to your personnel file. Formal evaluations will be conducted minimally, annually, based on how one meets, exceeds, or fails at standards specified within this position description. NOTICE: This position in no way states or implies that the responsibilities and tasks are the only responsibilities and tasks to be performed by the employee occupying this position. The employee will be required to follow any other instructions and to perform any other job-related duties as required by the employee's immediate supervisor. The requirements are minimum knowledge, skills, and abilities to qualify for this position. The incumbent will possess the skills and aptitudes to perform each task proficiently to perform the duties and responsibilities of this position successfully. "Ability" means to have and apply both knowledge and skill.

$27-45 hourly