RN Care Manager (Bilingual Spanish)

The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our practice engagement team. Clover has built one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers. The RN Care Manager (RNCM) collaborates closely with members, their health providers, and Clover clinical teams to improve member health outcomes.

To do so, the RNCM facilitates member assessments, evaluations, care planning, care coordination, and advocacy related to a member’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on high quality and cost effective outcomes. The RN Care Manager will report directly to the Manager, Clinical Care Management.

As a RN Care Manager, you will: Engage and provide telephonic care coordination and management to identified patient populations. g. In-Home Care team, Readmission Prevention Program team, Supportive Care team, Behavioral Health team, field Nurse Practitioners, Medical Assistants).

Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care. Create a personalized care plan for each member to resolve barriers to care and engage with social support systems as appropriate. Follow NCQA Care management accreditation standards.

Document all member care activities and escalate findings in accordance with Clover Policies. Coordinate with the interdisciplinary team as needed, including members’ outpatient providers. Provide telephonic teaching and counseling in the areas of health promotion, disease prevention, maintenance, and management of acute/chronic diseases.

Attend and participate in regular ongoing meetings. Demonstrate flexibility in assignments within Clover’s Clinical Programs based on member and company needs. Advocate for members to ensure their needs and choices are fully represented and supported.

Participate in ongoing professional development and self-improvement. You should get in touch if: You have at least 3 years of post-licensure care management experience. You hold a Bachelor’s degree (BSN) or higher from an accredited school of nursing.

You possess a current valid RN multi-state license. You can communicate fluently in English and Spanish, both orally and in writing You have a Case Management certification or completion of CCM certification within 1 year of employment (preferred). You have experience in completion of assessment, care plans, care coordination, and issue resolution.

You are knowledgeable about healthcare reimbursement, utilization management, discharge planning, and disease management. You have experience in geriatrics and chronic illness management. You have basic knowledge of Medicare and Medicare Advantage Plans.

You are comfortable with documenting electronic medical records and utilizing electronic data and reports. You have intermediate level computer skills on Mac and PC platforms.

Benefits

Overview : Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive hourly rate.

Compensation

reviews to recognize and reward exceptional contributions. Support for Our Clinicians: Professional liability (malpractice) coverage, Clover-branded scrubs, Personal Protective Equipment (PPE), mileage reimbursement at the IRS rate, license and certification renewal reimbursement, and WiFi reimbursement for select roles. Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage.