Nursing Care Coordinator

2 weeks ago

Newnan, Georgia, 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.

We believe that a diverse team of passionate innovators is essential to transforming the healthcare landscape and supporting individuals living with chronic conditions. Are you ready to make a difference?

Our Commitment to Values

At Somatus, we cultivate an inclusive workplace that encourages collaboration and innovation at every level. Our core values guide our mission and influence every decision we make:
  • Authenticity: We engage in genuine conversations, staying true to ourselves in all interactions with patients, partners, and colleagues.
  • 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 when it concerns our patients' well-being.
  • Innovation: We continuously seek ways to enhance our services and deliver new solutions.
  • Tenacity: We view challenges as opportunities for growth, especially when they lead to better outcomes for our patients and partners.

Benefits We Offer

We provide over 25 health, growth, and financial benefits to support our teammates 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 to support physical and mental health
  • Community engagement initiatives
  • And more

Role Responsibilities

The RN Care Manager plays a vital role within a multidisciplinary care team that includes nurses, dietitians, pharmacists, social workers, community health workers, and physicians. This position focuses on working closely with complex renal patients through various methods, including home visits, telehealth, and electronic communication. The primary goal is to enhance patient outcomes by:
  • Conducting thorough assessments that encompass 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.
  • Developing and implementing personalized care plans in collaboration with patients, nephrologists, primary care providers, and other care team members to address identified needs and improve health.
  • Acting as an advocate and resource for patients, their families, and healthcare providers.
  • Facilitating care transitions across various settings, including home, hospital, skilled nursing facilities, and acute care environments.
  • Managing patient care during transitions to minimize avoidable readmissions.
  • Educating patients about their renal conditions and providing self-management support.
  • Conducting ongoing assessments and follow-ups to enhance patient outcomes.
  • Providing clinical oversight to a team of community health workers, health coaches, social workers, and renal dietitians, delegating tasks as appropriate.

Success Metrics

Key performance indicators include:
  • Building strong provider relationships
  • Monitoring and coordinating dialysis interventions
  • Effective medical management

Qualifications

Required:
  • Minimum of 1 year of nursing experience in case management or care management, preferably in a multi-setting environment.
  • At least 2 years of healthcare-related experience.
  • Current, unrestricted compact Registered Nurse license.
  • All team members must maintain valid BLS certification from an accredited provider.
  • Core values aligned with a patient-centered care approach.
  • Proactive patient advocacy and problem-solving 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 sensitivity.
  • Strong analytical and critical thinking abilities, along with community engagement skills.
  • Willingness to travel within the assigned region 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 (e.g., ESRD, geriatrics, minorities, low-income, uninsured).
  • Ability to build rapport with patients and families through active listening.
  • Familiarity with electronic medical records.
  • Community outreach experience is a plus.
  • Proficiency in MS Office and telecom devices.

Additional Information

Please note that this job description is not exhaustive and may be subject to change. Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 vaccination is required for employment, with reasonable accommodations considered for those unable to be vaccinated for medical or religious reasons. Somatus, Inc. is an equal opportunity employer, committed to treating all individuals fairly, regardless of race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by law. Discrimination of any kind is not tolerated.

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