Patient Health Advocate

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 #Somatus Strong 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.

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

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.

• 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.

• Patient Engagement
• Care Setting Transitions
• Assessment
• Monthly Goal completion as set by the RNCM
• Patient Success – as measured by…