SlipstreamJobs tracks this role from the company's public career site. Apply directly on the employer's site.
Salary: USD 78,000 - 98,000 / annual
Somatus is a leading provider of outcomes-driven care for individuals living with chronic conditions, partnering with health plans, health systems, and provider groups to support patients with cardio, kidney, metabolic, and other chronic conditions.
The Registered Nurse Care Manager, VBC role focuses on high-needs Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD) populations. You will work closely with Somatus patients and physician practices, serving as a primary representative within practices and building trusted relationships with nephrology teams. This is a hybrid field-based role requiring regular travel (approximately 75% of the time) to member homes, dialysis clinics, and physician offices within the Queens, NY area.
Key responsibilities include:
- Conduct outreach and schedule face-to-face visits with high-risk members to perform barrier assessments and deliver care plan education
- Establish and maintain positive relationships with patients and provider offices through in-person and telephonic engagement
- Develop strong partnerships with provider practice teams to support clinical and operational goals
- Collaborate on workflows that align with operational objectives and care team processes
- Educate provider practices on the Somatus program and integrated workflows
- Provide comprehensive assessments, transitional care assessments, and reassessments through in-person, telehealth, or phone interaction
- Utilize nursing assessment skills to identify medical, behavioral, and social determinants of health barriers
- Develop and implement individualized care plans in collaboration with patients, nephrologists, PCPs, and the interdisciplinary care team
- Manage patient transitions of care to minimize preventable readmissions
- Provide clinical guidance and oversight to non-licensed and licensed team members
- Participate actively in Care Management Coordination Committee (CMCC) meetings
You will work with a multidisciplinary team including community health workers, health coaches, social workers, and renal dietitians. The role requires strong communication skills, cultural awareness, computer proficiency (MS Office, telecom devices), and the ability to adapt to changing work environments based on member and client needs.
Qualifications:
- Active RN license with ability to obtain licensure in other states as needed
- 2+ years of RN experience, including working as part of a multidisciplinary team with physicians
- Valid BLS certification from a licensed AHA or American Red Cross training facility/provider
- Renal, Chronic Kidney Disease, or Dialysis Care experience as a main focus of your job
- Reside in a location with access to high-speed internet connection
- Comfortable traveling to partner hospitals, clinics, and community-based facilities within assigned region; regular local travel is essential
- Ability to remain seated or standing for extended periods
- Ability to work assigned schedule to meet patient and client expectations
Preferred Qualifications:
- BSN or higher level of education
- Certified Case Manager (CCM) credential
- Field-based experience going into homes
- Telephonic case management experience
Required for employment: Proof of COVID-19 vaccination, annual Influenza vaccination, and immunizations for Hepatitis, MMR, Varicella, Tdap, and TB.
