RN Care Manager (Bilingual Spanish)

About the role

The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our practice engagement team. Clover has built one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers.

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, 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.
• Career development and self-improvement.
• Advocate for members to ensure their needs and choices are fully represented and supported.

Requirements

• 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.

Qualifications

• You have 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.

Skills

• Knowledgeable about healthcare reimbursement, utilization management, discharge planning, and disease management.
• Experience in geriatrics and chronic illness management.
• Basic knowledge of Medicare and Medicare Advantage Plans.
• Intermediate level computer skills on Mac and PC platforms.

Benefits

• Financial Well-Being: Competitive hourly rate, performance-based bonus program, 401k matching, and regular compensation reviews.
• Support for Our Clinicians: Professional liability (malpractice) coverage, Clover-branded scrubs, Personal Protective Equipment (PPE), mileage reimbursement at the IRS rate, license and certification renewal reimbursement, and WiFi reimbursement for select roles.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Company holidays, access to mental health resources, and a generous time-off policy.
• Professional Development: Paid Continuing Medical Education (CME) days, a role-based CME allowance, learning programs, mentorship, and regular performance feedback and reviews.

Pay

A reasonable estimate of the base salary range for this role is: $92,000 - $105,000 USD

Schedule

Full-time employees accrue up to 18 days of vacation per year.