Bilingual Spanish, RN Care Manager

About the Role

As a key member of the clinical care management team, the RN Care Manager will report directly to the Manager, Clinical Care Management. The role requires a strong ability to work independently, think critically, and make informed decisions that prioritize patient needs. The RN Care Manager will also participate in ongoing professional development to stay updated on best practices in care management.

The success of the RN Care Manager will be measured by their ability to engage patients, facilitate care planning, and advocate for patient needs. This role offers the opportunity to make a meaningful difference in the lives of patients and their families, working in a fast-paced environment that values innovation and patient-centered care.

What You Will Do

• Engage and provide telephonic care coordination and management to identified patient populations.
• Collaborate with members of Clover's clinical teams, including the In-Home Care team, Readmission Prevention Program team, Supportive Care team, and Behavioral Health team.
• Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care.
• Create personalized care plans for each member, addressing barriers to care and engaging social support systems as needed.
• Document all member care activities and escalate findings in accordance with Clover's policies.
• Coordinate with the interdisciplinary team, including members' outpatient providers.
• Provide telephonic teaching and counseling on health promotion, disease prevention, and management of acute and chronic diseases.
• Attend and participate in regular ongoing meetings to discuss patient care and outcomes.
• 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.

What We Are Looking For

• At least 3 years of post-licensure care management experience.
• A Bachelor's degree (BSN) or higher from an accredited school of nursing.
• A 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 in 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 with documenting electronic medical records and utilizing electronic data and reports.
• Intermediate-level computer skills on Mac and PC platforms.

Nice to Have

• Experience with electronic health records (EHRs) and care management software.
• Certification in a relevant specialty, such as gerontology or palliative care.
• Bilingual proficiency in additional languages, besides Spanish.

Benefits and Perks

• Competitive hourly rate.
• Performance-based bonus program.
• 401k matching and regular compensation reviews.
• Professional liability (malpractice) coverage.
• Clover-branded scrubs and Personal Protective Equipment (PPE).
• Mileage reimbursement at the IRS rate.
• License and certification renewal reimbursement.
• WiFi reimbursement for select roles.
• Comprehensive medical, dental, and vision coverage.
• Flexible work arrangement, allowing for remote work.

• Ensure your nursing license is up to date and you have the required experience in care management before applying.
• Highlight your ability to work independently and as part of a team, as well as your critical thinking and problem-solving skills.
• Being fluent in Spanish is crucial; be prepared to discuss how you can effectively communicate with Spanish-speaking patients and their families.
• Familiarize yourself with Clover Health's approach to care management and their use of technology to drive patient outcomes.
• Prepare examples of your experience with care planning, coordination, and patient advocacy to discuss during the interview.
• Consider obtaining or highlighting any relevant certifications, such as case management or disease management certifications, to stand out as a candidate.
• Research the company culture and values to understand how you can contribute to and thrive in Clover Health's environment.