Chronic Nurse Counsellor

Job Description

Provides education to patients on disease processes, disease management and health promotion to empower patient self-management, maintain wellbeing and prevent complications
Works with individual patient to develop and revise health plans according to needs
Tracks patient’s results, conducts telephone consultations to monitor and assess needs, and encourages patients to achieve desired health outcomes (builds relationship with patients)
Will perform tests and assessment for patients (e.g. CAT, ACT)
Will carry out DFS/DRP for patients
Works with anchor doctors to drive improvement in chronic disease management outcomes
Make necessary recommendations or referrals for patient needing services e.g. financial, social etc

Requirement:

Excellent knowledge of chronic diseases & care pathways (e.g. respiratory disorders, coronary heart disease, diabetes, mental health, arthritis, etc.)
Currently practicing chronic nurse e.g case manager in hospital
Senior Staff Nurse Level prefer to have advanced diploma in general nursing or best chronic diseases e.g Diabetes, Renal etc
At least need 1 yr experience or exposure to CDM in acute hospital setting
44 hours/week, Regular clinic hours, 5.5 work week
Able to travel around as need to move from one clinic to another
Able to speak Mandarin and Dialect as the clinics are mainly handling elderly patients
Nurses dealing with dialysis as chronic disease will also be considered
Singaporean and PR only