Adult Care Management Registered Nurse, RN

OU Health•Oklahoma City, OK

About The Position

Care Management RNs coordinate care and services for selected patient populations and support efficient use of healthcare resources. The role assesses, plans, implements, coordinates, monitors, and evaluates services and options to meet patients’ healthcare needs while promoting quality outcomes and patient satisfaction. The position is scheduled Monday through Friday on days. The role may be filled at Level 1, 2, or 3 depending on education, experience, and license requirements.

Requirements

Level 1: Associate’s degree or higher in nursing.
Level 1: 0–3 years of nursing experience; care management experience preferred.
Level 2: Bachelor’s degree in nursing and at least 3 years of care management experience.
Level 3: Bachelor’s degree in nursing and at least 5 years of care management experience.
Current Registered Nurse license issued by the Oklahoma State Board of Nursing or a current multistate compact Registered Nurse (eNLC) license.
Basic Life Support certification from the American Heart Association; required for Level 3 in an inpatient setting.
Expertise in regulatory requirements for the care management discipline and strong knowledge of healthcare regulations, including CMS guidelines.
Strong communication, interpersonal, leadership, assessment, critical-thinking, and problem-solving skills.
Detailed orientation and excellent organizational skills.
Commitment to continuous learning, quality improvement, and patient-centered care.
Understanding of utilization management principles and ability to integrate them with care management responsibilities.
Ability to serve as a liaison between patients, families, and healthcare providers.
Proficiency with electronic health records (EHR) and care management software.

Nice To Haves

Care management experience for Level 1.

Responsibilities

Conduct comprehensive assessments of patients’ health status, medical history, and ongoing care needs.
Develop individualized care plans with the interdisciplinary healthcare team, patients, and families to support continuity of care.
Educate patients and families about health conditions, treatment plans, medications, financial expectations, and self-care strategies.
Coordinate communication among patients, families, healthcare providers, and community resources to optimize care outcomes.
Evaluate care-plan effectiveness and adjust plans as needed.
Evaluate healthcare utilization patterns and identify opportunities to improve efficiency and cost-effectiveness.
Advocate for appropriate resource and service allocation while following regulatory guidelines and reimbursement criteria.
Collaborate with insurance providers, social workers, and other stakeholders to support timely service authorization and patient coverage.
Monitor patient outcomes, healthcare processes, and care delivery systems to identify improvement opportunities.
Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practice, patient safety, and satisfaction.
Ensure compliance with applicable federal, state, and local regulations and accreditation requirements related to care management and patient care.
Implement strategies to minimize readmissions, prevent complications, and optimize care planning.
Perform other duties as assigned.