Adult Care Management RN - Emergency Dept (Full Time)

OU Health•Oklahoma City, OK

About The Position

The Adult Care Management RN works in the Adult Emergency Department and coordinates care and services for selected patient populations, ensuring efficient use of healthcare resources. The role assesses, plans, implements, coordinates, monitors, and evaluates services needed to meet patients’ healthcare needs while promoting quality outcomes and patient satisfaction. The position may be filled at Level 1, 2, or 3, depending on education, experience, and license requirements. Care Management RNs collaborate with patients, families, interdisciplinary healthcare teams, insurers, social workers, and community resources to support continuity of care, appropriate resource use, regulatory compliance, and improved patient outcomes.

Requirements

Associate’s degree or higher in nursing for Level 1; bachelor’s degree in nursing for Levels 2 and 3.
Level 1: 0–3 years of nursing experience required.
Level 2: At least 3 years of care management experience required.
Level 3: At least 5 years of care management experience required.
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, the posting specifies this requirement for the inpatient setting.
Expertise in regulatory requirements related to care management.
Strong communication, interpersonal, and leadership skills.
Attention to detail and excellent organizational skills.
Commitment to continuous learning, quality improvement, and patient-centered care.
Strong assessment, critical-thinking, and problem-solving skills.
Strong knowledge of healthcare regulations, including CMS guidelines.
Understanding of utilization management principles and ability to integrate them into care management responsibilities.
Ability to serve as a liaison among patients, families, and healthcare providers.
Proficiency with electronic health records (EHR) and care management software.

Nice To Haves

Care Management experience is preferred 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 ensure 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 outcomes.
Evaluate care-plan effectiveness and adjust plans as necessary.
Evaluate healthcare utilization patterns and identify opportunities to improve efficiency and cost-effectiveness.
Advocate for appropriate allocation of resources and services while adhering to regulatory guidelines and reimbursement criteria.
Collaborate with insurance providers, social workers, and other stakeholders to obtain timely service authorizations and coverage.
Monitor and evaluate patient outcomes, healthcare processes, and care delivery systems to identify areas for improvement.
Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practice and improve patient safety and satisfaction.
Ensure compliance with 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 processes.
Perform other duties as assigned.