Lumeris Complex Case Manager, Advanced Illness (RN, Case Manager) in St. Louis, Missouri
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Complex Case Manager, Advanced Illness (RN, Case Manager)
The Complex Case Manager, Advanced Illness at Lumeris will provide telephonic care and case management to Medicare members as part of a multidisciplinary care team. The Advanced Illness program focuses on members in advanced or end stages of diseases with complex needs for symptom management, coordination with the Primary Care Physician, and member caregivers. The Complex Case Manager will offer members health and disease education and empower them to actively participate in their care. Other duties of the Complex Case Manager include but are not limited to: Consultation with members on their medications and durable medical equipment, review member care plans, address home care needs, and connect members to community resources; collaboration with primary care physicians and other providers to ensure there are no gaps in care; collaboration with members, providers, and care givers to ensure positive care outcomes during care transitions.
Make outbound calls to assess member’s current health status
Provide patient education to assist with self-management
Educate members on disease processes
Encourage members to make healthy lifestyle changes
Empower members and caregivers to have conversations in advance with each other and their provider about end of life choices
Identify gaps or barriers in treatment plans
Coordinate care for members
Collaborate closely with interdisciplinary team
Make referrals to outside sources
Coordinate services such as home health, DME, as needed
Ensure that discharged members receive the necessary services and resources, including medication reconciliation
Document and track findings in a computerized system
Interact with providers
Support other Complex Case Management programs within the department as needed
Collaborate with medical management staff in development of new programs.
* After a period of in-house orientation and contingent on satisfactory work performance, this is a work from home position.
** In-house orientation will be virtual while the office is closed during the pandemic.
Experience, Qualifications, and Education Required :
Current licensure in good standing as a registered nurse in the state of Missouri and Illinois and eligibility for licensure in other states
Two years minimum experience in a hospital or home health case management setting
Must be proficient with computers, have the ability to type and talk simultaneously, and have excellent interpersonal and customer service skills, including telephone etiquette.
Must be able to multi-task and prioritize on a daily basis
Must be flexible and adaptive to a changing environment
Must take and pass case management certification (CCM) within 2 years of hire
Must maintain CCM certification during employment
Experience, Qualifications, and Education Preferred :
Previous experience as a telephonic case manager for a Medicare insurance plan
Case management certification
BSN or experience with telephonic case management
Hospice or Palliative care experience
- While performing the duties of this job, the employee works in normal office working conditions.
- The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.
St. Louis, MO
Join Our Growing Team!
Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.
Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.