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.
The RN Care Manager (RNCM) collaborates closely with members, their health providers, and Clover clinical teams to improve member health outcomes. To do so, the RNCM 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 RN Care Manager will report directly to the Manager, Clinical Care Management.
As a Bilingual Spanish 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.
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.
Benefits Overview:
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
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.
A reasonable estimate of the base salary range for this role is $86,000 to $105,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.