Nurse Care Manager (RN)

Telligen•Oklahoma City, OK

6d•Hybrid

About The Position

As a Nurse Care Manager (RN), you will manage the care of patients with acute and chronic medical conditions and assess the care needs of vulnerable populations for various clients. This hybrid position is based at either Telligen’s West Des Moines, Iowa, office or its Oklahoma City, Oklahoma, office. The position is contingent on Telligen obtaining a new, pending contract.

Requirements

Four-year degree in health care or a related field, and/or equivalent training and/or experience.
At least 1 year of experience in human services and/or 3 years of clinical practice experience.
Licensure as a health care provider or a current RN license.
State-specific licensure may be required for some contracts; state licensure is required for different clients in numerous states.

Nice To Haves

Certain positions may require advanced certifications or the ability to obtain certifications within 4 years.

Responsibilities

Assess and evaluate potential care management patients in accordance with client contractual obligations and/or state requirements.
Collaborate with health care providers and ancillary service providers to validate appropriate treatment plans and identify educational opportunities.
Conduct assessments and education, including face-to-face interactions when required by specific contracts.
Guide members to appropriate member benefit information.
Provide ongoing education.
Communicate with health care providers to ensure appropriateness of care.
Recommend and make adjustments to care when needed.
Evaluate treatment adherence and reassess the patient's commitment to making necessary changes.
Document individual member status and/or medical necessity review and negotiation according to contractual requirements.
Escalate issues through appropriate channels and established protocols between clinical and non-clinical staff.
Perform miscellaneous duties as assigned.