Wellness Nurse Care Manager

Summary

Join Clover as an RN Care Manager and collaborate with members, providers, and clinical teams to improve health outcomes. You will engage in telephonic care coordination, create personalized care plans, and advocate for members' needs. Responsibilities include assessments, care planning, and coordinating with interdisciplinary teams. This role requires a BSN, RN license, and care management experience. A Case Management certification is preferred. Clover offers a competitive salary and a mission-driven environment focused on improving healthcare.

Requirements

• Have 3-5 years of post-licensure care management experience
• Hold a Bachelor’s degree (BSN) from an accredited school of nursing
• Possess a current valid RN multi-state license
• Have extensive experience in patient assessment, care plan development, care coordination, and issue resolution
• Be knowledgeable about healthcare reimbursement, utilization management, discharge planning, and disease management
• Be comfortable with documenting electronic medical records and utilizing electronic data and reports
• Have intermediate-level computer skills on Mac and PC platforms

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, and 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

• Have a Case Management certification or completion of CCM certification within 1 year of employment
• Have a foundational understanding of Medicare and Medicare Advantage Plans
• Be able to communicate fluently in English and Spanish, both orally and in writing

Benefits

A reasonable estimate of the base salary range for this role is $68,800 to $105,000