RN Care Manager
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Job Description
RN Care Manager role at Clover Health collaborating with clinical teams for proactive member care. Focused on assessments, care planning, and coordination to enhance member health outcomes.
Responsibilities:
- Engage and provide telephonic care coordination and management to identified patient populations
- Effectively collaborate with members of Clover clinical teams
- Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care
- Create a personalized care plan for each member
- 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 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
- Advocate for members to ensure their needs and choices are fully represented and supported
- Participate in ongoing professional development and self-improvement
Requirements:
- At least 3 years of post-licensure care management experience
- Bachelor’s degree (BSN) or higher from an accredited school of nursing
- Current valid RN multi-state license
- Case Management certification or completion of CCM certification within 1 year of employment (preferred)
- Experience in completion of assessment, care plans, care coordination, and issue resolution
- Knowledgeable about healthcare reimbursement, utilization management, discharge planning, and disease management
- Experience in geriatrics and chronic illness management
- Basic knowledge of Medicare and Medicare Advantage Plans
- Comfortable with documenting electronic medical records and utilizing electronic data and reports
- Intermediate level computer skills on Mac and PC platforms
- Fluent in English and Spanish, both orally and in writing (preferred)
Benefits:
- Financial Well-Being: competitive base salary and equity opportunities, performance-based bonus program, 401k matching, regular compensation reviews
- Physical Well-Being: comprehensive medical, dental, and vision coverage
- Mental Well-Being: initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, generous flexible time-off policy, remote-first culture
- Professional Development: learning programs, mentorship, professional development funding, regular performance feedback
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