Clover is reinventing health insurance by working to keep people healthier.
Our care management programs are designed to improve care and outcomes for our 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.
As a Nurse Care Manager you will collaborate closely with members, their health providers, and Clover clinical teams to improve member health outcomes. To do so, you’ll facilitate 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. You will report directly to the Lead Nurse Care Manager.
As a Nurse Care Manager, you will:
- Engage and provide telephonic care coordination and management to identified member 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
- BSN from accredited program, required
- Valid New Jersey nursing license, required
- Case management certification, strongly 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
- Proficiency in computer use, required; EMR experience, eClinicalWorks preferred.
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.