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RN Care Manager (Bilingual Spanish)

1 month, 1 week ago
United States
Full-time
Mid Level
Operations Specialist
Customer and Technical Support
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 23

Description

  • Engage with identified patient populations through telephonic care coordination and management.
  • Collaborate with Clover clinical teams, including in-home care, readmission prevention, supportive care, behavioral health, and field staff.
  • Initiate specialty referrals, follow up on open referrals, and support continuity of care.
  • Create personalized care plans to address barriers to care and connect members with social support systems as needed.
  • Follow NCQA care management accreditation standards and Clover policies for documentation and escalation.
  • Document member care activities and escalate findings appropriately.
  • Coordinate care with the interdisciplinary team, including members’ outpatient providers.
  • Provide telephonic teaching and counseling on health promotion, disease prevention, and acute and chronic disease management.
  • Advocate for members to ensure their needs and preferences are represented and supported.
  • Participate in regular meetings, professional development, and flexible clinical program assignments as needed.

Requirements

  • At least 3 years of post-licensure care management experience.
  • Bachelor’s degree in nursing (BSN) or higher from an accredited school of nursing.
  • Current, valid RN multi-state license.
  • Fluency in English and Spanish, both orally and in writing.
  • Case Management certification, or completion of CCM certification within 1 year of employment (preferred).
  • Experience completing assessments, care plans, care coordination, and issue resolution.
  • Knowledge of healthcare reimbursement, utilization management, discharge planning, and disease management.
  • Experience in geriatrics and chronic illness management.
  • Basic knowledge of Medicare and Medicare Advantage plans.
  • Comfort documenting in electronic medical records and using electronic data and reports.
  • Intermediate computer skills on Mac and PC platforms.

Benefits

  • Competitive hourly rate with a performance-based bonus program and regular compensation reviews.
  • 401(k) matching.
  • Professional liability (malpractice) coverage, Clover-branded scrubs, PPE, mileage reimbursement, and license/certification renewal reimbursement.
  • Comprehensive medical, dental, and vision coverage.
  • Generous time-off policy, including up to 18 vacation days per year, 10 federal holidays, 4 additional paid holidays, and 1 floating holiday.
  • Paid Continuing Medical Education (CME) days, a role-based CME allowance, learning programs, mentorship, and performance feedback.
  • Reimbursement for office setup expenses.
  • Employee Stock Purchase Plan (ESPP) with discounted equity opportunities.
  • Paid parental leave for all new parents.
  • Mental health resources and company holidays.

Interested in this position?

Apply directly on the company website

Apply Now

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