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Nurse Care Coordinator

2 months ago

San Bernardino, California, United States Somatus Full time

Position Overview

As a prominent leader in value-based kidney care, Somatus is dedicated to enhancing the lives of patients with chronic kidney disease, ensuring they spend more time at home and less in hospitals.

Our Mission

We believe that a collaborative and innovative approach is essential in transforming healthcare for individuals managing chronic conditions. Are you ready to contribute to our mission of creating More Lives, Better Lived?

Our Values

At Somatus, we cultivate an inclusive workplace that encourages teamwork and creativity. Our core values guide our mission and influence every decision we make:

  • Authenticity: We prioritize genuine communication in all interactions, ensuring honesty and transparency.
  • Collaboration: We value the unique contributions of each team member, believing that together we can achieve greater outcomes.
  • Empowerment: We ensure that every voice is heard and every idea is valued, particularly in relation to patient care.
  • Innovation: We are committed to continuously seeking improvements and new solutions to enhance patient care.
  • Tenacity: We view challenges as opportunities for growth, particularly when they lead to better patient outcomes.

Benefits for You

We provide over 25 health, growth, and wealth perks to support our team members in their personal and professional development, including:

  • Subsidized healthcare coverage (medical, dental, vision)
  • Accrual of 3 weeks of paid time off (PTO)
  • Professional development opportunities, including CEUs and tuition reimbursement
  • Wellness benefits that support physical and mental health
  • Community engagement initiatives
  • And more

Role of the RN Care Manager

The RN Care Manager plays a vital role within a multidisciplinary care team, collaborating with nurses, dietitians, pharmacists, social workers, community health workers, and physicians. This position focuses on improving patient outcomes for complex renal patients through home visits, telehealth, and electronic communication.

Key Responsibilities

  • Conduct thorough assessments encompassing medical, behavioral, pharmaceutical, and social needs, identifying care gaps and health barriers. The RN Care Manager is expected to perform approximately 12 assessments weekly and manage a panel of around 150 patients.
  • Develop and implement individualized care plans in collaboration with patients, nephrologists, primary care providers, and the care team, addressing identified needs and barriers.
  • Act as an advocate and resource for patients, their families, and healthcare providers to ensure coordinated care.
  • Facilitate care transitions across various settings, including home, hospital, and skilled nursing facilities.
  • Support patients during transitions of care to minimize avoidable readmissions.
  • Educate patients on their renal conditions and promote self-management strategies.
  • Provide ongoing reassessment and follow-up to enhance patient outcomes.
  • Oversee non-licensed community health workers and licensed social workers and dietitians, delegating tasks as appropriate.

Success Metrics

  • Strengthening provider relationships
  • Monitoring and coordinating dialysis interventions
  • Effective medical management

Qualifications

Required:

  • Minimum of 1 year of nursing experience in case or care management, preferably across multiple settings.
  • At least 2 years of healthcare-related experience.
  • Current, unrestricted compact Registered Nurse license.
  • Valid BLS certification from an accredited provider.
  • Core values aligned with a patient-centered care approach.
  • Proactive patient advocacy and resolution skills.
  • Ability to empower patients in self-management and shared decision-making.
  • Strong collaboration skills with team members.
  • Effective communication skills, demonstrating respect and cultural awareness.
  • Strong analytical and critical thinking abilities.
  • Willingness to travel and conduct home visits as needed.

Preferred:

  • Bachelor's degree in nursing.
  • Demonstrated empathy, enthusiasm, and a strong work ethic.
  • Experience with vulnerable patient populations.
  • Ability to build rapport through active listening.
  • Familiarity with electronic medical records.
  • Community outreach experience.
  • Proficiency in MS Office and telecommunications.

Salary Range

$100,000 to $110,000

Compensation will be determined based on various factors, including qualifications, skills, and experience.

Additional Information

This job description is not exhaustive and may be subject to change. Our priority is the health and safety of our members and team. Proof of COVID-19 vaccination is required for employment, with accommodations considered as per policy.

Somatus, Inc. is an equal opportunity employer, committed to diversity and inclusion in the workplace.