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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Lead Nurse Care Manager
New Jersey, US
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

Our care management programs are designed to improve care and outcomes for our most medically complex members. Clover wants to take accountability for every member’s healthcare journey and provide high-quality personalized care that is consistent with our members’ values and preferences.

The Lead Nurse Care Manager will work with the Nurse Practitioner Manager and other clinical operations staff to ensure that Clover’s telephonic care coordination and management programs provide high quality care and operate efficiently and effectively. This position will support the mission, vision, values and strategic initiatives of Clover and must demonstrate a commitment to quality service to members, physicians, the community and colleagues. The Lead Nurse Care Manager will report directly to the Nurse Practitioner Manager.

As a Lead Nurse Care Manager, you will be responsible for the following items and additional tasks as needed and directed by the Nurse Practitioner Manager:

  • Identify and assist in the implementation of quality improvement opportunities, especially as they apply to the program’s Wellness Nurse Care Managers.
  • Assist in the development of educational materials and trainings for program Nurse Care Managers.
  • Complete quality reviews of direct reports’ work, through direct observation of daily activities and review of phone recordings.
  • Coach and performance management of the Nurse Care Managers.
  • Assist in the development of department policies and procedures .
  • Manage the Workforce management of the Nurse Care Manager team, (e.g PTO, call outs, case assignments, etc)
  • Prepare reporting of the Nurse Care Manager’s team quality for weekly quality reviews with Nurse Practitioner Managers
  • Partner with the team to onboard new Nurse Care Managers
  • Participate in care coordination referrals and manages a smaller case load of members consistent with the wellness manager job description.

You will love this job if:

  • You are passionate about helping others and being a patient, positive, and collaborative leader.
  • You love clinical care with the goal of providing the best outcomes for older and frail members.
  • You are humble and understand that as a manager of people, you are there to serve and support others.
  • You can distill the needs of your members and team members down to actionable improvements that can be made in Clover’s product or procedures. And, you can do it while fiercely protecting the privacy and rights of our customers.
  • You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.

You should get in touch if you have:

  • 3-5 years of post-licensure care management experience
  • BSN from accredited program, required
  • Valid New Jersey nursing license, required
  • Case management certification, required
  • Basic proficiency in computer use, required; EMR experience, eClinicalWorks preferred. 
  • 1-2 years of clinical oversight experience of other nurses and allied health providers delivering care in a care/case management capacity, required. 3-5 years, preferred
  • Geriatrics certification, preferred
  • Basic knowledge of Medicare, Medicare Advantage Plans, preferred
  • Knowledge of geriatrics and chronic illness
  • Knowledge of healthcare reimbursement, utilization management, discharge planning, disease management
  • Excellent interpersonal skills and an ability to communicate effectively with members and colleagues alike
  • You are comfortable working with members of diverse social, ethnic, and cultural backgrounds

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.