Nurse Care Manager

State of Oklahoma • Oklahoma City, OK

23d • $65,607 • Onsite

About The Position

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.

Requirements

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
• 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.
• 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.

Nice To Haves

• 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

Responsibilities

• 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.
• Evaluates the quality of services provided by licensed and non-licensed health care members.
• 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 client's diagnosed condition.
• Other duties as assigned.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees