RN Care Manager (Bilingual Spanish)

As a RN Care Manager, you will:

• 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.

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. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Support for Our Clinicians: [truncated]