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Position:
Complex Case Manager Position Summary:
Provides telephonic care and case management to Medicare members as part of a multidisciplinary care team. Offers members education, empowerment and consultation to help improve member care. Collaborates with care team to ensure there are no gaps in care. Collaborates with members, providers, and care givers to ensure positive care outcomes during care transitions. Job Description:
Primary Responsibilities
- Offers members health and disease education and empowers them to regularly participate in their care. Encourages members to make healthy lifestyle changes.
- Provides consultation to members on their medications and durable medical equipment.
- Reviews member care plans, addresses home care needs, and connects members to community resources.
- Makes outbound calls to assess member's current health status.
- Provides patient education and use Motivational Interviewing to assist with self-management.
- Creates and monitors personalized member plans of care.
- Educates members on disease processes.
- Identifies gaps or barriers in treatment plans.
- Coordinated care for members.
- Makes referrals to outside sources.
- Coordinates services such as home health, DME, as needed.
- Ensures that discharged members receive the necessary services and resources, including medication reconciliation.
- Documents and tracks findings in a computerized system.
- Interacts with providers and a multi-disciplinary care team.
- Collaborates with medical management staff in development of new programs.
- Remains committed to member and department success and works to assist the team in meeting goals.
- Trains and mentors new employees.
- 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
- 5+ years of clinical nursing experience including 2+ years of experience in a hospital or home health case management setting or the knowledge, skills, and abilities to succeed in the role
- Ability to take and pass case management certification (CCM) within 2 years of hire and to maintain CCM certification during employment
- Proficient computer skills with the ability to learn and apply new technologies
- Ability to type and talk simultaneously
- Considerable initiative and ability to prioritize workload and respond to changing demands/timelines
- Ability to guide team projects or processes
- Strong judgement and critical thinking skills with a proven ability to assess member needs and develop a plan of care
- Flexible and adaptive to a changing environment
- Effective communication and relationship building skills with the ability to influence and positively impact members
- Excellent interpersonal and customer service skills, including telephone etiquette
- Effective training and mentoring skills
Preferred
- BSN or experience with telephonic case management
- Case management certification
- Previous experience as a telephonic Case Manager for a Medicare insurance plan
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.
#LI-Remote
Lumeris is an EEO/AA employer M/F/V/D.
The hiring range for this position is:
$72,800.00-$97,400.00Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our
Careers Page
. Member Facing Position:
No- Not Member Facing Position Location:
Alabama, Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina {+ 15 more} Time Type:
Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.
