RN Care Manager

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Requirements:

• 3-5 years of post-licensure care management experience.
• Bachelor’s degree (BSN) from an accredited nursing school.
• Current unencumbered NJ licensure as a Registered Nurse.
• Case management certification or completion of CCM certification within 1 year preferred.
• Experience with assessments, care plans, care coordination, and issue resolution.
• Knowledge of healthcare reimbursement, utilization management, and disease management.
• Knowledge of geriatrics and chronic illness.
• Basic knowledge of Medicare and Medicare Advantage Plans.
• Proficient in electronic medical records and data documentation.
• Intermediate proficiency with Mac/PC computer skills.

Responsibilities:

• Engage and provide telephonic care coordination and management to identified patient populations.
• Collaborate with Clover clinical teams including Home Care, Readmission Prevention, Supportive Care, and Behavioral Health.
• Initiate and follow up on referrals to specialty services.
• Create personalized care plans to address barriers to care.
• Document member care activities and escalate findings per Clover Policies.
• Provide telephonic health education and counseling.
• Attend ongoing meetings and participate in professional development.