Bilingual RN Care Manager

• Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
• Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
• Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
• Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.
• Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

• Subsidized, personal healthcare coverage (medical, dental vision)
• Accrual of 3 weeks’ Vacation (PTO)
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!

• Conduct comprehensive assessments that include the medical, behavioral, pharmaceutical, and social needs of the patient, identify gaps in care and barriers to good health; The RN Care Manager is expected to conduct approximately 12 assessments per week and manage a panel of about 150 assessed patients.
• Based on this assessment, and in conjunction with the patient, patient’s nephrologist & PCP, and other members of the care team, create and implement a care plan that will address identified needs, remove barriers to care, and improve the health of the patient;
• Coordinate care by serving as the advocate and resource for the patient, their family, and their provider(s);
• Facilitate care across the continuum of care, spanning settings such as the home, hospital, skilled nursing facility, and acute care facility;
• Manage patients during periods of transitions of care to facilitate effective transitions and minimize avoidable readmissions;
• Assess the patient’s knowledge of their renal condition and provide education and self-management support;
• Provide ongoing reassessment and follow-up to improve patient outcomes.
• Provide clinical oversight to non-licensed support team of community health workers and health coaches and licensed support team of social workers and renal dietitians, and delegate tasks as appropriate.

• Provider Relationships.
• Dialysis Interventions monitoring and coordination.
• Medical Management.

• 1+ years of nursing experience in case management or care management, preferably coordinating care across multiple settings.
• Current Registered Nurse license.
• Must be fluent in both English and Spanish.
• Core values consistent with a patient-centered approach to care.
• Proactively acts as a patient advocate and responds with resolve.
• Knowledge and experience to empower patients in self-management and shared decision making.
• Enjoys working collaboratively with team members.
• Effective written and verbal communication skills demonstrating respect and cultural awareness during interactions with clients.
• Strong analytical and critical thinking skills. Strong community engagement and facilitation skills.
• Access to reliable transportation for travel within the assigned region and comfort with conducting home visits (50-75% same day travel).

• Bachelor’s Degree in Nursing.
• Demonstrates empathy, enthusiasm, a great sense of humor, and a strong work ethic.
• Experience working with vulnerable patient population (ESRD, geriatrics, minorities, low income, uninsured, etc.).
• Ability to establish rapport with patient and family by inquiring and listening.
• Familiar with electronic medical records.
• Community Outreach experience, preferred.
• Competence using MS Office products and telecom devices.

Somatus, Inc.