Somatus

Title: Registered Nurse Care Manager Location: Bethesda United States Job Description: As a leading provider of outcomes-driven care for individuals and communities living with chronic conditions, Somatus is helping patients across the country enjoy More Healthy Days at Home™. Care at Somatus goes beyond treatment. Through a whole‑person approach, we deliver outcomes‑driven integrated care and show up #SomatusStrong for our patients and teammates. We partner closely with health plans, health systems, and provider groups to support patients with, or at risk of developing, cardio, kidney, metabolic, or other chronic conditions. We hire the brightest and boldest — talent driven by purpose and impact. Since our founding in 2016, our growth trajectory isn’t just a milestone — it’s a signal. Our leadership values culture and leads with intention as we remain dedicated to driving clinical excellence. Does this sound like you? Keep reading. How We’ll Support You: We offer 25+ health, growth, and wealth work perks to help teammates be the best version of themselves, including: - 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 How You'll Make an Impact: The RN Care Manager is a critical member of the care team consisting of nurses, dietitians, pharmacists, social workers, community health workers, and physicians. This position will be working closely with complex renal patients in their home, dialysis center, by phone and electronically as needed. The primary focus will be to improve patient outcomes by helping patients get permanent access, promoting home dialysis modalities & kidney transplantation, educating patients on self-management, addressing risks associated with comorbid conditions, and coordinating their care. Working in a Hybrid Telehealth environment with a combination of remote days and visits to members’ homes if needed for that market. - 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. Measures of Success - Provider Relationships - Dialysis Interventions monitoring and coordination - Medical Management This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. How You'll Strengthen Our Team: Qualifications: - 1+ years of nursing experience in case management or care management, preferably coordinating care across multiple settings. - 2+ years healthcare related experience. - Current, unrestricted compact Registered Nurse license - Requires all teammates to maintain current, valid BLS certification ONLY from a licensed AHA or American Red Cross training facility or provider. - 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 - Ability to travel throughout the assigned region and comfort with conducting home visits depending on the assigned market needs. Preferred Qualifications: - 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. Salary Range $78,000 to $90,000 Per year Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience and may fall outside of the range shown

Title: Registered Nurse Care Manager Location: Mclean United States Job Description: How We Show Up for Our Patients: As a leading provider of outcomes-driven care for individuals and communities living with chronic conditions, Somatus is helping patients across the country enjoy More Healthy Days at Home. Care at Somatus goes beyond treatment. Through a whole‑person approach, we deliver outcomes‑driven integrated care and show up #SomatusStrong for our patients and teammates. We partner closely with health plans, health systems, and provider groups to support patients with, or at risk of developing, cardio, kidney, metabolic, or other chronic conditions. We hire the brightest and boldest - talent driven by purpose and impact. Since our founding in 2016, our growth trajectory isn't just a milestone - it's a signal. Our leadership values culture and leads with intention as we remain dedicated to driving clinical excellence. Does this sound like you? Keep reading. How We'll Support You: We offer 25+ health, growth, and wealth work perks to help teammates be the best version of themselves, including: - 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 How You'll Make an Impact: The RN Care Manager is a critical member of the care team consisting of nurses, dietitians, pharmacists, social workers, community health workers, and physicians. This position will be working closely with complex renal patients in their home, dialysis center, by phone and electronically as needed. The primary focus will be to improve patient outcomes by helping patients get permanent access, promoting home dialysis modalities & kidney transplantation, educating patients on self-management, addressing risks associated with comorbid conditions, and coordinating their care. Working in a Hybrid Telehealth environment with a combination of remote days and visits to members' homes if needed for that market. - 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. Measures of Success - Provider Relationships - Dialysis Interventions monitoring and coordination - Medical Management This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. How You'll Strengthen Our Team: Qualifications: - 1+ years of nursing experience in case management or care management, preferably coordinating care across multiple settings. - 2+ years healthcare related experience. - Current, unrestricted compact Registered Nurse license - Requires all teammates to maintain current, valid BLS certification ONLY from a licensed AHA or American Red Cross training facility or provider. - 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 - Ability to travel throughout the assigned region and comfort with conducting home visits depending on the assigned market needs. Preferred Qualifications: - 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. Our Commitment to Diversity: Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy and applicable law. At Somatus, we celebrate what makes us unique - our people. We believe that a culture intentionally built to foster and support our unique passions, experiences, and perspectives helps fuel us in the pursuit of our mission. 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.

Title: Patient Health Advocate Location: Annapolis United States Job Description: How We Show Up for Our Patients: As a leading provider of outcomes-driven care for individuals and communities living with chronic conditions, Somatus is helping patients across the country enjoy More Healthy Days at Home. Care at Somatus goes beyond treatment. Through a whole‑person approach, we deliver outcomes‑driven integrated care and show up #SomatusStrong for our patients and teammates. We partner closely with health plans, health systems, and provider groups to support patients with, or at risk of developing, cardio, kidney, metabolic, or other chronic conditions. We hire the brightest and boldest - talent driven by purpose and impact. Since our founding in 2016, our growth trajectory isn't just a milestone - it's a signal. Our leadership values culture and leads with intention as we remain dedicated to driving clinical excellence. Does this sound like you? Keep reading. How We'll Support You: We offer 25+ health, growth, and wealth work perks to help teammates be the best version of themselves, including: - 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 How You'll Make an Impact: Somatus offers a Hybrid Telehealth environment with a combination of remote days and visits to members' homes. This position will be focused 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. The CHW-Patient Advocate will work as an extension of the clinical care team, specifically under the guidance of RN Care Manager and act as an advocate guiding them through their care needs. The individual taking this role will manage his/her caseload through in-person, telephonic and electronic means of communications and coordination. The Patient Advocate will be the first and primary representative of Somatus to our members. He/she will be the key holder of the patient relationship and trust and will be responsible for building this relationship. He or she will be tasked as the person that schedules the initial wellness exam and care management assessment meeting with Somatus clinicians. After an individual care plan is developed, will be the person that facilitates connecting and scheduling the many resources within and beyond Somatus to the patient (including the various members of our care team as well as PCPs, Nephrologists, etc.). The Patient Advocate will also be involved in the community to "plug in" the patient with others and help facilitate their overall wellbeing. This position is a market-based position. - Works under the guidance of physicians and/or a nurse care manager. - Follow-up with health management plans and goals. - Establish positive, supportive relationships with participants and provide feedback. - Conduct an initial triage assessment to help align patients with the most appropriate program in accordance with program guidelines. - Documents their activities in the care coordination platform, including care plan activities conducted. - Engages with patients who need assistance with self-care needs in addition to what a nurse care manager can provide via phone, such as: - - Address language and cultural barriers to care management and self-care. - Coach and guide the patient to meet both personal and clinical goals. - Schedules provider appointments on behalf of their patients. - Accompanies patients to their appointments when needed. - Reminds patients of their upcoming appointments. - Helps patients access community and government-based services, including possibly filling out paperwork for the patient. - Helps to teach the caregiver about symptom response plans. - Arranges transportation. - Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing. - Assists patients with enrolling to access educational videos. - Participates in the integrated care team meetings. - Act as the patient advocate and support the member through their patient journey starting with initial outreach. - Conduct telephonic outreach to members within designated geographic area to introduce the Somatus program and encourage enrollment to build their patient caseload. - Conduct door-to-door engagement outreach for patients with telephonic barriers. - Support NP and RNCM care team members through facilitating in home telehealth visits with patients. - Utilize motivational interviewing techniques to encourage patients to make behavioral changes. Measures of Success - Patient Engagement - Care Setting Transitions - Assessment - Monthly Goal completion as set by the RNCM - Patient Success - as measured by no/reduced hospital or ER visits on a monthly basis This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. How You'll Strengthen Our Team: Qualifications: - Experience working with Medicare, Medicaid or Special Needs populations. - High school diploma or GED required . - Medical Assistant, Licensed Practical Nurse, Engagement Specialist or Community Health Worker Experience. - Ability to connect with people and understand the challenges they face. - Ability to use a range of outreach methods to engage individuals and groups in diverse settings. - Well connected to the community and resources within the community they will serve. - Effective written and verbal communication skills demonstrating respect and cultural awareness during interactions with clients. - Ability to travel throughout the assigned region and comfort with conducting home visits (50-75% same day travel). - Great motivator - Organized Coach - Empathetic - Outgoing / positive personality Preferred Qualifications: - Experience working with patients with chronic and behavioral health needs. - Associates degree or higher from an accredited college preferred. - Demonstrated success in working as part of a multi-disciplinary team including communicating and working with Physicians and Registered Nurses. - Proven experience with engaging patients in making healthy behavior changes. - Proven skills in navigating the health systems and making necessary linkages in order to meet specific needs. - Experience working with Electronic Medical Records and other documentation platform. Wage Range $21.00- $23.00 Per Hour Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience and may fall outside of the range shown This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Our Commitment to Diversity: Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy and applicable law. Our Commitment to Diversity: At Somatus, we celebrate what makes us unique - our people. We believe that a culture intentionally built to foster and support our unique passions, experiences, and perspectives helps fuel us in the pursuit of our mission. 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.