Chronic Disease Management Nurse (RN) - Upper Grand FHT (Fergus)

Organization Name
Upper Grand FHT (Fergus)
Chronic Disease Management Nurse (RN)
FTE Type
Full-Time Permanent

107-6420 Beatty Line North
Fergus ON N1M 2W3

Closing date

The Upper Grand Family Health Team (UGFHT) offers the opportunity to join an innovative, community-based primary health care team serving the Arthur, Fergus, and Elora areas. We are looking for a talented team player to join us as we continue to provide a model of excellence in rural primary health care.
Position Summary
As a member of an inter-professional team, the Chronic Disease Management Nurse will provide preventative and chronic disease management programs primarily for metabolic, cardiac and pulmonary patients of the FHT. You will provide primary care and be a resource to family physicians, other allied health professionals, and the community. You will develop, implement, and evaluate programs and strategies working with individual patients, community groups, and agencies to improve and maintain health.

  • Baccalaureate of Science in Nursing required
  • Registered with the College of Nurses of Ontario. RNAO membership preferred
  • Certified Diabetes Educator (CDE) an asset
  • Minimum three years demonstrated experience in a primary health care (family medicine) or community health care setting preferred
  • Demonstrated experience in one or more additional areas of clinical leadership: mental health, asthma and COPD, cardiac care, smoking cessation
  • Knowledge and competency in current, evidence-based methods and practices of primary care delivery, with an emphasis on health promotion and disease prevention
  • Ability to prioritize, manage time effectively and be flexible in a very active work environment
  • Strong interest and experience in program development, implementation, facilitation and evaluation of health promotion, disease prevention and chronic disease management programs
  • Able to function as a team player working collaboratively with other FHT staff and community partners
  • Sound organizational, teaching and leadership skills
  • Valid Ontario Driver’s license and access to own reliable vehicle
  • Proficiency in the use of computer and communication system knowledge including e-mail and Electronic Medical Records (EMRs)


  • Occasional after-hours support as required
  • Determine the need for, and the implementation of health promotion and prevention strategies for families and individuals
  • Maintain professional competence and remain current (e.g. evidenced-based care) through ongoing participation in professional development, FHT research projects, etc.

Skills and Abilities

  • Demonstrated skills in assessment, program development, implementation and evaluation of health promotion, disease prevention and chronic disease management programs
  • Ability to keep confidential all information regarding patients, health care providers, employees, business operations and clinic/team functioning
  • Professionalism displayed through mannerisms, attire and response to stressful situations
  • Organizational ability to prioritize a wide range of job activities with accuracy and speed
  • Communication skills which reflect the ability to work well in a team environment while maintaining respect and attentiveness to patients and fellow team members
  • Interpersonal skills to listen effectively and to train and help develop patients, new employees and students
  • Problem solving skills to identify and effectively solve problems and to help patients and team members solve problems
  • Time management abilities to effectively set priorities and complete tasks within agreed upon timeframes

How to Apply

Interested candidates should submit a cover letter and résumé by Friday, June 25 2021 to:

  • Cohl Johnston, HR Manager
  • Upper Grand Family Health Team
  • Trailside Medical, 107-6420 Beatty Line N, Fergus ON N1M 2W3
  • click here for e-mail
  • Fax: (519) 843-7386

The Upper Grand Family Health Team supports diversity, equity and a workplace free from harassment and discrimination. They encourage applications from all qualified candidates, including women, visible minorities, aboriginal peoples and persons with a disability. Accommodations are available upon request for candidates at any point in the selection process. Please direct questions and/or requests by e-mail (click here). They appreciate the interest of all applicants, however, only those selected for an interview will be contacted.