Diabetes Program Navigator - Clinic - Tulsa

Minimum Qualifications

Education – Graduation as a BSN, RN from an accredited professional school of nursing.

Experience – A minimum of one (1) year of experience in healthcare, patient services, community outreach, care coordination, or related field preferred.

Licenses & Certification –RN license required. Certified Diabetes Care and Education Specialist (CDCES) preferred.

Knowledge & Skills –

1. 
   

   Knowledge of diabetes prevention, management, and diabetes-related complications.

   
   


2. 
   

   Knowledge of healthcare systems, patient navigation principles, and community resources.

   
   


3. 
   

   Understanding of social determinants of health and barriers to healthcare access.

   
   


4. 
   

   Knowledge of tribal culture, traditions, and community resources preferred.

   
   


5. 
   

   Strong interpersonal, communication, and customer service skills.

   
   


6. 
   

   Expertise in nursing care for patients with diabetes.

   
   


7. 
   

   Ability to establish and maintain effective working relationships with patients, families, healthcare providers, and community partners.

   
   


8. 
   

   Ability to conduct outreach and engage patients from diverse backgrounds.

   
   


9. 
   

   Ability to document accurately and maintain required records and reports.

   
   


10. 
    

    Proficiency in electronic health records and standard office software.

    
    

JOB SUMMARY

The purpose of this position is to assist patients with a diagnosis of diabetes in accessing and navigating healthcare services, diabetes education, and community resources. The diabetes navigator works closely with patients, providers, diabetes educators, case managers, and community partners to improve patient engagement, reduce barriers to care, and promote positive health outcomes. The position supports diabetes prevention and management initiatives through patient outreach, care coordination, resource referral, and health promotion activities.

 WORK ENVIRONMENT

Work is performed in an office and clinical environment. Some travel may be required and may require driving a GSA vehicle to other Diabetes Program facilities to perform job duties.

PHYSICAL DEMANDS

Work requires the demands of normal office and clinical work within the MCNDH clinics. Must have valid license and be insurable.

ESSENTIAL FUNCTIONS

Satisfactory job performance will be determined by successful execution of the following:

1. 
   

   Conduct patient outreach and assist with scheduling, referrals, screenings, and follow-up services to promote participation in diabetes education, preventive care, and related programs.

   
   


2. 
   

   Identify barriers to care and connect patients with appropriate tribal, community, and healthcare resources.

   
   


3. 
   

   Reinforce diabetes self-management education and healthy lifestyle recommendations provided by licensed healthcare professionals.

   
   


4. 
   

   Track patient participation, referrals, and follow-up activities; maintain accurate electronic health record documentation; and assist with diabetes registry management.

   
   


5. 
   

   Collaborate with healthcare providers, diabetes educators, nurses, case managers, clinical pharmacists, and community health representatives to coordinate patient care.

   
   


6. 
   

   Participate in community health fairs, wellness events, screenings, and outreach activities.

   
   


7. 
   

   Maintain confidentiality of patient information and comply with all applicable policies, procedures, and regulations.

   
   


8. 
   

   Support population-based strategies to prevent diabetes and reduce diabetes-related complications within Muscogee communities.

   
   


9. 
   

   Assist with diabetes registry activities to identify individuals due for preventive services, screenings, education, or follow-up.

   
   


10. 
    

    Conduct targeted outreach based on identified population health needs and gaps in diabetes services.

    
    


11. 
    

    Participate in community-based diabetes prevention, screening, wellness, and health education activities.

    
    


12. 
    

    Assist Public Health leadership in identifying recurring barriers affecting populations or communities and opportunities for system-level improvement.

    
    


13. 
    

    Support culturally responsive approaches to diabetes prevention, health promotion, education, and outreach within Muscogee communities.

    
    


14. 
    

    Assist with monitoring diabetes program performance measures and population health indicators.

    
    


15. 
    

    Help identify disparities, service gaps, barriers, and opportunities for improvement using program and population-health data.

    
    


16. 
    

    Perform other duties as assigned.