Job Description

Esse Health is the largest independent physician practice in the St. Louis Metropolitan area with over 100 physicians, in 35+ locations, serving nearly 130,000 patients. We are leading the health care community by placing patients and their physicians at the center of health decisions. Esse Health is more than a healthcare provider - it's a place where medicine is a calling and not just a profession. It's a team of extraordinary medical professionals with the latest ideas for keeping patients healthier.

Join Our Team:

Esse Health is searching for a compassionate full-time RN Care Manager to join our team! The RN Care Manager is an integral part of the care management team, working in collaboration with Primary Care Physicians to enhance patient health outcomes. Utilizing nursing principles of assessment, diagnosis, planning, implementation, and evaluation, the RN Care Manager delivers both face-to-face and telephonic care coordination. This role focuses on eliminating barriers to care, facilitating smooth care transitions, managing discharge planning, and supporting patients throughout their healthcare journey.

The RN Care Manager works in tandem with the patient, their family, and healthcare teams to ensure follow-up care, education, resources, and home health needs are addressed to reduce hospital remissions and improve patient outcomes. All responsibilities are carried out in accordance with federal and state regulations and standards of nursing practice.

Opportunity:

• Full-time
• Monday - Friday, 8:00 a.m. - 5:00 p.m.
• No nights, weekends or holidays.
• Benefit eligible.
• Position will be housed out of our HUB/Central office located at 555 Maryville University Drive. You may primarily work from home. At certain times, attendance will be mandatory in the office (meetings, training, Esse Health employee events, etc.).
• Position model may move to seeing patients in the hospital and skilled nursing facilities.

Day-to-Day:

• Understands and implements the core objectives of the Esse RN Care Management program.
• Conducts timely and comprehensive face-to-face and follow-up visits with patients across various community settings.
• Acts as a liaison for the Esse Health Primary Care Physician, coordinating communication and care planning among patients, families, and healthcare providers.
• Determines the need for follow-up care based on patient acuity, therapy progress, medical conditions, and social service interventions.
• Develops and manages individualized discharge plans with input from the patient, family, PCP, and interdisciplinary care teams.
• Reviews facility notes and provider documentation to reassess discharge and care plans.
• Identifies potential barriers in the home and community environment that may impact recovery or quality of life.
• Applies evidence-based medicine guidelines and assessment tools to ensure high-quality care.
• Coordinates home care services including skilled nursing, therapy, durable medical equipment (DME), and community-based resources.
• Partners with PCP offices to schedule timely post-discharge appointments and ensure continuity of care
• Completes documentation accurately, thoroughly, and on time within the designated electronic medical records (EMR) system.

Qualifications:

• Diploma from an accredited School of Nursing required
• Active RN license in Missouri and Illinois (or eligibility)
• Certified Case Manager (CCM) preferred or at least three years of nursing experience
• Strong working knowledge of Medicare benefits and services
• Experience in discharge planning and cross-functional care coordination
• Proficient in EMR systems and digital documentation
• Ability to work independently, prioritize tasks, and manage a caseload
• Strong organizational skills with high attention to detail

What We Offer:

• Competitive compensation
• Benefits within your first 30 days
• Available benefits: Medical, Dental, Vision, Life, Long/Short Term Disability, Health Savings Account/Flexible Spending Account, Fraud Protection, Legal, Pet and other miscellaneous
• Generous PTO policy + 9 paid holidays
• 401k match + profit sharing
• Tuition reimbursement
• Wellness program
• Opportunities for professional growth and mentorship
• Emphasis on work-life balance
• Modern facilities and integrated care teams

EOE