Registered Nurse (RN) - Care Manager
Oklahoma City Rehabilitation Hospital
Oklahoma City, OK

RN Health Care Management Nurse/Nurse Care Manager

Job Posting Title RN Health Care Management Nurse/Nurse Care Manager Agency 807 HEALTH CARE AUTHORITY Supervisory Organization Population Care Management Job Posting End Date (Continuous if Blank) December 09, 2024 Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above. Estimated Appointment End Date (Continuous if Blank) Full/Part-Time Full time Job Type Regular Compensation $65,607.00 / annual Job Description Agency/Division Information The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. Position Purpose The Nurse Care Manager ensures that medically complex and special healthcare needs of SoonerCare members are effectively managed by coordinating access to medical care, community resources, and social services. This role involves conducting clinical reviews, facilitating care management activities, and collaborating with intra- and inter-agency personnel to ensure program adherence to state and federal guidelines. Additionally, the Nurse Care Manager supports the agency's mission by providing leadership in resolving member issues, contributing to case management decisions, and advocating for the needs of vulnerable populations while ensuring compliance with OHCA policies and program requirements. Principle Activities May Include * Coordinate and facilitate access to medical care for medically complex/special health care needs members identified through various referral sources including self-referrals, provider referrals, and other state agency referrals. Facilitate access to community resources and social service agencies within the parameters of the SoonerCare program. * Conduct clinical reviews and document Care Management activities utilizing the clinical case management system and other available tools. Complete level of care determinations and assessments for identified populations using standardized tools and processes. Prepare cost-effectiveness statements, reports, and other necessary documentation. * Collaborate with intra-agency and inter-agency personnel regarding policy and program issues related to Care Management. Participate in case staffing meetings and collaborate with other agency staff to ensure coordination of efforts. Provide testimony as requested for adjudication of administrative appeals. * Interface verbally and in writing with members, families, and providers to resolve issues. Act as a SoonerCare Care Management resource, answering questions for OHCA personnel related to the complex special needs of identified members. * Work with internal and external QA processes to monitor program adherence to state and federal guidelines and contracts. Represent OHCA SoonerCare in public forums involving various stakeholder groups, informational seminars, and training sessions as assigned. * Evaluate appropriateness for healthcare services for identified clients and make recommendations for care plans based on established guidelines for the clients diagnosed condition. * Other duties as assigned. Knowledge, Skills, Abilities, and Competencies The Nurse Care Manager requires in-depth knowledge of healthcare policies, clinical case management, and community resource coordination, along with the ability to communicate effectively with members, providers, and agencies. Strong problem-solving skills and strategic thinking are necessary for navigating complex healthcare systems, ensuring compliance, and advocating for members with special healthcare needs. The Korn Ferry competencies that best align with this role include Ensures Accountability (demonstrating ownership for program adherence and compliance) and Collaborates (working effectively with diverse internal and external stakeholders to provide comprehensive care management). To be considered for this position your application must include a resume/CV with complete work and education history. Education and/or Experience: * Possession of a valid permanent Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC) * AND * 2 years of professional nursing experience. Preference may be given to candidates with: * Experience as an Exceptional Needs Coordinator, Nurse Case Manager or Quality Assurance/Utilization Review Nurse * Advanced Health-related Education (e.g. MSN) * Experience with the Uniform Comprehensive Assessment Tool (UCAT) * Experience with aged, blind or disabled population * Experience with Medicaid/SoonerCare * Related Professional Certifications (other than BLS/ALS/PALS) * Experience with MS , Excel, Access, PowerPoint * Bilingual Physical Demands: * Must be able to remain sitting for prolonged periods at a desk and working on a computer. * Must be able to move or lift up to 15 pounds at various times. Work Environment: The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines. Benefits Highlights OHCA is proud to provide a comprehensive benefits package designed to support our employees and their dependents. Our benefits include: * Generous state paid benefit allowance to help cover insurance premiums. * A wide choice of best-in-class health insurance plans. * Optional flexible spending accounts for health care expenses or dependent care. * Employee assistance program and health and fitness programs. * 11 paid holidays. * 15 days of vacation and 15 days of sick leave the first year. * Retirement Savings Plan with a generous contribution. * Longevity Bonus for years of service. * Public Service Loan forgiveness and educational assistance reimbursement program. * Training opportunities for CEU requirements. Accommodation Statement: The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335. Notice to applicants: Please add [email protected] to the address book or "safe-senders" list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093. Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above. Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub. Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.