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Lumeris Complex Case Manager in St. Louis, Missouri

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Position:

Complex Case Manager

Position Summary:

The Complex Case Manager at Lumeris will provide telephonic care and case management to Medicare members as part of a multidisciplinary care team. 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.

Job Description:

Primary Responsibilities

  • 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

  • Identify gaps or barriers in treatment plans

  • Coordinate care for members

  • 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 and a multi-disciplinary care team

  • 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.

Qualifications

  • 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

  • Previous experience as a telephonic case manager for a Medicare insurance plan preferred

  • Case management certification preferred

  • BSN or experience with telephonic case management preferred

REPORTS TO: Manager, Case Management

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

  • 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.

Location:

St. Louis, MO

Time Type:

Full time

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.

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