RN Care Manager (Float/Travel)

Somatus

Roanoke, VA, US
  • Job Type: Full-Time
  • Function: Life Sciences R&D/Engineering
  • Post Date: 02/16/2021
  • Website: www.somatus.com
  • Company Address: 1861 International Dr, McLean, Virginia 22102, US

About Somatus

Somatus partners with leading health plans, health systems, nephrology and primary care groups to provide integrated care for patients with or at risk of developing kidney disease. As the market leader in value-based kidney care, Somatus’ vertically integrated clinical services and technology delay or prevent disease progression, decrease avoidable hospital utilization, improve quality and care coordination, and increase the use of home dialysis modalities and rates of kidney transplantation.

Job Description

The Float - Relief Registered Nurse 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 with Transition of Care, 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. This individual will step into multiple care teams to cover patients in the absence of the permanent nurse care manager. The individual must easily build relationships with co-workers and rapidly build trust with members to continue all work in progress.

DUTIES / ACTIVITIES:

CUSTOMER SERVICE:

  • Responsible for driving the Somatus culture through values and customer
  • Accountable for outstanding customer service to all external and internal
  • Develops and maintains relationships through effective and timely
  • Takes initiative and action to respond, resolve and follow up regarding customer service issues with all parties in a timely

PRINCIPLE RESPONSIBILITIES AND DUTIES:

  • Conduct comprehensive assessments that include the medical, behavioral, pharmaceutical, and social needs of the patient, identify gaps in care and barriers to good health.
  • 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
  • Provide accurate and comprehensive transitions for members from primary nurse care manager, to the float manager and back again.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • Moderately active work involves lifting and carrying, walking and standing for considerable lengths of time.
  • Talking and listening to communicate ideas or requirements to individual staff members.
  • Visual acuity to prepare and read written material accurately.
  • Audio acuity to listen attentively and accurately.
  • Ability to push, pull, mobilize (with assistance of wheels, carts, and other equipment) approximately 50 lbs.
  • Ability to work overtime as needed to complete general responsibilities.
  • Full use of all extremities with hand dexterity.
  • Ability to travel when necessary to meet the needs of the unit and corporation.

NOTE: For individuals that meet the standards for the American Disability Act (ADA), reasonable accommodations will be made to ensure equal opportunity to fulfill physical demands and improve working conditions. 

EDUCATION:

  • Bachelor’s degree in Nursing preferred

EXPERIENCE AND REQUIRED SKILLS:

  • 3-5 years of nursing experience in case management or care management, preferably coordinating care across multiple settings
  • Current, unrestricted compact Registered Nurse license
  • 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
  • Ability to travel throughout the assigned state and comfort with conducting home visits (up to 50% same day travel)

Preferred

  • 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

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. This role may require overnight travel throughout the Float Nurse’s designated State of employment.

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This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.