Complex Care Manager

Role Overview

• Provides telephonic care management to Medicare members with complex and high-risk health needs as part of a multidisciplinary care team.
• 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.

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

Benefits

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...