RN Care Manager

At least 3 years of post-licensure care management experience. Bachelor’s degree (BSN) or higher from an accredited school of nursing. Current valid RN multi-state license. Case Management certification or completion of CCM certification within 1 year of employment (preferred). Experience in completion of assessment, care plans, care coordination, and issue resolution. 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. Comfortable with documenting electronic medical records and utilizing electronic data and reports. Intermediate level computer skills on Mac and PC platforms. Communicate fluently in English and Spanish, both orally and in writing (preferred).

Engage and provide telephonic care coordination and management to identified patient populations. Effectively collaborate with members of Clover clinical teams. Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care. Create a personalized care plan for each member. Follow NCQA Care management accreditation standards. Document all member care activities and escalate findings. Coordinate with the interdisciplinary team, including members’ outpatient providers. Provide telephonic teaching and counseling. Attend and participate in regular ongoing meetings. Demonstrate flexibility in assignments. Advocate for members. Participate in ongoing professional development and self-improvement.