Complex Care Manager

Lumeris

1d•Remote

About The Position

Provides telephonic care management to Medicare members with complex and high-risk health needs as part of a multidisciplinary care team. This role focuses on preventing avoidable hospital readmissions, improving chronic disease control (including members with elevated A1C levels), and closing care gaps during critical transitions. Offers clinical education, empowerment, and consultation to help members better manage their health while positively influencing overall plan performance and quality outcomes. Collaborates closely with members, providers, caregivers, and internal partners to deliver coordinated, holistic care.

Requirements

Current licensure in good standing as a Registered Nurse in Missouri or Illinois (both preferred), with eligibility for licensure in additional states as required.
5+ years of clinical nursing experience, including at least 2+ years in hospital discharge planning, home health, case management, nurse navigator, or similar care coordination setting.
Demonstrated ability to assess complex clinical situations and develop actionable plans of care.
Ability to obtain and maintain Case Management Certification (CCM) within 2 years of hire.
Experience coordinating care across physicians, pharmacies, DME suppliers, and home health providers.
Comfort working in a telephonic, high-volume outreach environment.
Ability to talk and type simultaneously while maintaining documentation quality.
Proficient computer skills with the ability to quickly learn new systems and technologies.
Strong prioritization skills and ability to adapt to shifting program focus.
Excellent communication, relationship-building, and customer service skills.
Ability to work independently while contributing to a collaborative team culture.

Nice To Haves

BSN.
Telephonic care or case management experience.
Experience supporting Medicare populations.
Current CCM certification.
Health plan–based care management experience.

Responsibilities

Conduct proactive telephonic outreach to Medicare members with complex and high-risk medical needs.
Prioritize members recently discharged from the hospital to reduce 30-day readmissions and improve care transitions.
Support members with uncontrolled chronic conditions, including diabetic members with elevated A1C levels, through structured follow-up and education.
Assess member health status through both outbound and inbound calls (average 15–20+ outreach calls per day).
Provide individualized health and disease education using Motivational Interviewing techniques to promote engagement and self-management.
Develop, implement, and monitor personalized, comprehensive plans of care that address medical, behavioral, and social factors.
Perform medication reconciliation and identify potential barriers to adherence or treatment success.
Coordinate services across providers, pharmacies, durable medical equipment (DME) vendors, home health agencies, and community resources.
Collaborate with physicians, caregivers, and interdisciplinary teams to ensure continuity and quality of care.
Identify and address gaps in care across multiple diagnoses and care settings.
Adapt outreach focus and workflow as organizational priorities evolve.
Document member interactions accurately and efficiently in real time within electronic systems.
Participate in new program initiatives and continuous improvement efforts.
Contribute to a highly collaborative and cohesive team environment.
Provide training and mentorship to new team members as appropriate.