Registered Nurse Care Manager, VBC

Job Overview The RN Care Manager, VBC focuses on high‑needs Chronic Kidney Disease (CKD) and End‑Stage Kidney Disease (ESKD) populations that face multiple challenges, from accessing resources to adhering to a physician’s treatment plan. Responsibilities Partner closely with physicians and practice staff to establish a collaborative working relationship focused on improving patient outcomes. Serve as Somatus’ primary representative within the practice and build trusted relationships over time. Support the care team in planning, coordinating, and facilitating regular interdisciplinary care team meetings with partnered practices to improve outcomes for complex, high‑priority patients. Establish and maintain positive, supportive relationships with patients and provider offices through in‑person and telephonic engagement. Develop strong partnerships with provider practice teams to support both clinical and operational goals and improve the overall quality of patient care. Collaborate with provider practices to develop and optimize workflows that align with operational objectives and care team processes. Educate provider practices on the Somatus program and reinforce collaborative, integrated workflows. Provide a complete continuum of quality care through close communication with members via in‑person, telehealth, or on‑phone interaction, including comprehensive assessments, transitional care assessments, and reassessments. Travel to member homes, facilities, and physician offices to conduct visits, participate in care planning, and deliver care coordination services. Utilize nursing assessment skills to identify medical, behavioral, and social determinants of health barriers affecting the treatment plan. In collaboration with the patient, nephrologist, PCP, and interdisciplinary care team, develop and implement individualized care plans to address identified needs, remove barriers to care, and improve overall health outcomes. Manage patients through transitions of care by supporting effective handoffs and minimizing preventable readmissions. Assess the patient’s knowledge of their discharge care requirements and renal condition and provide education and self‑management support. Provide clinical guidance and oversight to both non‑licensed (community health workers, health coaches) and licensed (social workers, renal dietitians) team members, delegating tasks as appropriate. Perform other duties as assigned. Benefits Subsidized personal healthcare coverage: Medical, Dental & Vision, plus Wellness programs. Paid Time Off: Accrual of 3 weeks’ vacation (PTO). Professional development: CEU and tuition reimbursement. Qualifications RN license and ability to obtain licensure in other states as needed. 2+ years of RN experience, including working as part of a multi‑disciplinary team and physicians. Valid BLS certification ONLY from a licensed AHA or American Red Cross training facility or provider. Renal, Chronic Kidney Disease or Dialysis Care experience as the main focus of your job. Reside in a location that can receive a high‑speed internet connection or can leverage existing high‑speed internet service. Comfortable traveling to partner hospitals, clinics, and community‑based facilities within your assigned region to support care coordination, build relationships, and collaborate with clinical teams. Regular local travel is a key part of this role. Preferred Qualifications BSN or higher level of education. Certified Case Manager (CCM). Field‑based experience going into homes. Telephonic case management experience. Knowledge, Skills, and Abilities Knowledge and experience to empower patients in self‑management and shared decision‑making. Work collaboratively with interdisciplinary team members. Strong analytical and critical thinking skills. Strong community engagement and facilitation skills. Ability to consult with physicians and other team members to ensure that the care plan is successfully implemented. Participate actively in assigned Care Management Coordination Committee (CMCC) meetings. Core values consistent with a patient‑centered approach to care. Ability to adapt to a changing work environment based on member and client needs (field‑based or remote work). Self‑motivated with a strong work ethic. Effective written and verbal communication skills that demonstrate respect and cultural awareness during interactions with patients and clients. Computer proficiency, including strong data entry, utilizing MS Office (Word, Excel, PowerPoint, and Outlook), and telecom devices including the ability to type and talk at the same time while navigating multiple applications. Adheres to departmental policies and procedures. Physical Requirements Reside in a location that can receive a high‑speed internet connection or can leverage existing high‑speed internet service. Access to private dedicated home workspace free from distractions and to protect patient privacy regarding HIPAA and privacy regulations. Ability to travel throughout the assigned region to conduct home, provider, or facility visits, depending on the assigned market needs, as needed 75% of the time. Ability to work assigned schedule to meet patient and client expectations. Ability to remain in a seated or standing position for extended periods of time as required to perform essential job functions. Compensation $80,000 to $90,000 per year. We offer competitive compensation that reflects market conditions and recognizes the skills, experience, and contributions of our team members. Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies, experience, and geographic location and may fall outside of the range shown above. In addition, this position may be eligible for a discretionary performance‑based bonus in accordance with the Company’s applicable incentive compensation plans. Essential Medical Requirements This position requires proof of COVID‑19 vaccination, annual influenza vaccination, along with immunizations for Hepatitis, MMR, Varicella, Tdap, and TB for employment. Commitment to Diversity Somatus, Inc. provides equal employment opportunity to all individuals 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 type will not be tolerated. #J-18808-Ljbffr Somatus - Revolutionizing Kidney Care