Wellness Nurse Care Manager

Summary

Join Clover, a company reinventing health insurance, as a Wellness Nurse Care Manager. You will collaborate with members, providers, and Clover's clinical teams to improve member health outcomes. Responsibilities include care coordination, care planning, and advocacy, addressing medical, social, and financial needs. You will create personalized care plans, follow NCQA standards, and document all activities. This role requires strong communication, collaboration, and technology skills. The ideal candidate possesses experience in care management, a BSN, and current NJ RN licensure.

Requirements

• 3-5 years of post-licensure care management experience
• Bachelor’s degree (BSN) from an accredited school of nursing
• Current unencumbered NJ Licensure as a Registered Nurse
• Experience in completion of assessment, care plans, care coordination, and issue resolution
• Knowledge of healthcare reimbursement, utilization management, discharge planning, disease management
• Knowledge of geriatrics and chronic illness
• Comfortable with documenting in electronic medical record and utilizing electronic data and reports
• Intermediate level of proficiency with Mac/PC computer skills

Responsibilities

• Engage and provide telephonic care coordination and management to identified patient populations
• Effectively collaborate with members of Clover clinical teams (e.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

Preferred Qualifications

• Case management certification or completion of CCM certification within 1 year of employment
• Basic knowledge of Medicare, Medicare Advantage Plans