RN Care Manager – HCC Risk Adjustment & Value-Based Care

OU Health•Oklahoma City, OK

10d•Onsite

About The Position

OU Health is seeking a Registered Nurse Care Manager to support HCC risk adjustment, coding initiatives, and value-based care across ambulatory care settings. The role partners with providers, clinical teams, coding specialists, and payors to improve documentation accuracy, optimize risk capture, and support value-based care performance. Responsibilities include leading HCC education efforts, identifying coding and documentation opportunities, monitoring performance metrics, and ensuring compliance with risk adjustment guidelines. The position is described as a clinical leadership and project facilitation role rather than a traditional patient-facing care management position. Care Management RNs coordinate care and services for selected patient populations and support efficient utilization of healthcare resources. The role assesses, plans, implements, coordinates, monitors, and evaluates services to meet patients’ healthcare needs while promoting quality outcomes and patient satisfaction. This position is onsite in downtown Oklahoma City. It may be filled at Level 1, 2, or 3 depending on education, experience, and license requirements.

Requirements

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 is required; for Level 3, it is specified as required for an inpatient setting.
Strong communication, interpersonal, and leadership skills.
Strong assessment, critical-thinking, and problem-solving skills.
Detailed-oriented with excellent organizational skills.
Expertise in regulatory requirements regarding the care management discipline.
Strong knowledge of healthcare regulations, including CMS guidelines.
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.
Commitment to continuous learning, quality improvement, and patient-centered care.
Level 1: Associate’s degree or higher in nursing and 0–3 years of nursing experience.
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.

Nice To Haves

Care Management experience is preferred for Level 1.
Experience in HCC coding, risk adjustment, clinical documentation improvement, and value-based care.
Strong analytical and project leadership skills.

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 patient outcomes.
Evaluate the effectiveness of care plans and adjust them as needed.
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 support timely service authorization 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 practices 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.
Lead HCC education efforts and identify coding and clinical documentation opportunities.
Monitor performance metrics and support accurate risk capture and value-based care performance.
Perform other duties as assigned.