About the job
The Clover Care Services organization provides proactive support and care to our members via our clinical Clover Home Care teams, along with quality improvement services through our practice engagement team. Clover has developed one of the most forward-thinking, data-driven healthcare service platforms, and we are enthusiastic about the transformative impact of technology on the results we deliver to both patients and providers.
As a Bilingual Spanish RN Care Manager (RNCM), you will work collaboratively with members, their healthcare providers, and Clover's clinical teams to enhance health outcomes. Your role will involve facilitating member assessments, evaluations, care planning, coordination, and advocacy regarding comprehensive health needs. This includes addressing medical, social, developmental, behavioral, financial, and educational concerns, with an emphasis on achieving high-quality and cost-effective results. You will report directly to the Manager of Clinical Care Management.
Key Responsibilities:
- Provide telephonic care coordination and management for designated patient populations.
- Collaborate effectively with Clover's clinical teams, including the In-Home Care team, Readmission Prevention Program, Supportive Care team, Behavioral Health team, and field Nurse Practitioners.
- Initiate and follow up on referrals to specialty services, ensuring continuity of care.
- Develop personalized care plans for each member to overcome barriers to care, engaging with social support systems as appropriate.
- Adhere to NCQA Care management accreditation standards.
- Document all member care activities and escalate findings as per Clover policies.
- Coordinate with the interdisciplinary team as required, including outpatient providers.
- Deliver telephonic education and counseling on health promotion, disease prevention, and management of acute and chronic health conditions.
- Participate actively in regular ongoing meetings.
- Exhibit flexibility in assignments within Clover's Clinical Programs based on member and organizational needs.
- Advocate for members to ensure their needs and preferences are thoroughly represented and supported.
- Engage in continuous professional development and self-improvement.

