Director of Clinical Care Management at Clover Health
Jersey City, NJ, US
Clover is reinventing health insurance by working to keep people healthier.

Our care management team is based on a multidisciplinary approach aimed at providing Clover members with the best possible outcomes. Our growing team currently consists of a Nurse Practitioner Manager, field NP’s, field MA's, Wellness RN’s, Social Workers, Clinical Pharmacists and Utilization Management. We collaborate closely with departments across the organization to build and innovate healthcare technology.

In this role, you’ll work alongside the Medical Director of Care Management and be responsible for driving ideas and solutions to help our members improve their health. Your clinical expertise and advocacy could bring meaningful change to our population health management!

As the Director of Care Management, you will:

Provide on-site assistance in developing and implementing care management initiatives to achieve overall program goals.
Be responsible and accountable to the Medical Director of Care Management and Chief Medical Officer to help manage medical costs and ensure appropriate care management activity.
Closely monitor and analyze outpatient reports and identify trends. Develop and execute solutions to improve all resource management.
Participate in development of strategic planning for existing and expanding business.
Facilitate team processes to resolve problems regarding complex patient issues. Follow up on the results of the collaboration process.
Monitor all high risk/high cost patients in regard to care delivery, referrals, etc.
Identify opportunities to develop new care management approaches.
Lead and mentor staff reporting to this position.
Conduct monthly staff meetings with all team collaborators.
Identify, develop and oversee the educational needs of Care Management staff, providers and others.
Ensure that all operational processes are in compliance with all federal, state and accrediting body standards.
Use, protect, and disclose protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Perform additional duties as assigned.

You will love this job if:

You genuinely enjoy interacting with diverse individuals on a daily basis.
You want to make a positive difference; you're passionate about helping members live healthier lives.
Your mode of operation is being meticulous in your work and motivational to others.
Technology is your friend; you embrace learning about new software and working alongside a tech team.

You should get in touch if:

You have a current NP or RN license.
You have a care management certificate (preferred).
You have a Doctorate in Nursing Practice or BS in nursing degree.
You have 5-10 years of professional experience practicing in healthcare (required); a minimum of 3 years of experienceworking with providers and/or payers at a management level.
You have knowledge of care management regulations that fall under CMS, NCQA, and other applicable state and accreditation standards.
You have experience providing strategic leadership, managing teams and leading projects.
You have good analytical and problem-solving skills
You are committed to service excellence and patient satisfaction.
You have excellent written, verbal and interpersonal communication skills.
You are able to multi-task in a fast-paced environment.
You can empathize with culturally diverse members and communities.
You have aptitude for coaching, training and developing new teammates.
You have successfully built strong relationships across multiple functional lanes .

We are an E-Verify company.