Clover is reinventing health insurance by working to keep people healthier.
- Our complex care programs are designed to improve care and outcomes for our most medically complex members. Clover wants to take accountability for these members' healthcare journeys and provide high-quality personalized care that is consistent with members' values and preferences.
- The Wellness Nurse Care Manager collaborates closely with members, their health providers, and Clover clinical teams to improve member health outcomes. To do so, the WNCM 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 Wellness Nurse Care Manager will report directly to the program lead.
As an 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 will love this job if:
- You genuinely enjoy interacting with diverse individuals on a daily basis.
- You want to make a positive difference; you're passionate about helping members live healthier lives.
- Your mode of operation is being meticulous in your work and motivational to others.
- Technology is your friend; you embrace learning about new software and working alongside a tech team.
You should get in touch if you have:
- 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.
- 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.
- Knowledge of healthcare reimbursement, utilization management, discharge planning, disease management.
- Knowledge of geriatrics and chronic illness.
- Basic knowledge of Medicare, Medicare Advantage Plans, preferred.
- Comfortable with documenting in electronic medical record and utilizing electronic data and reports.
- Intermediate level of proficiency with Mac/PC computer skills.
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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
