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

OU Health•Oklahoma City, OK

12d•Onsite

About The Position

OU Health is seeking a Registered Nurse Care Manager to lead HCC risk adjustment and coding initiatives 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. It includes leading HCC education efforts, identifying coding and documentation opportunities, monitoring performance metrics, and ensuring compliance with risk adjustment guidelines. The posting describes this 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 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 is onsite in downtown Oklahoma City and 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 is 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 RN license issued by the Oklahoma State Board of Nursing or a current multistate compact Registered Nurse license (eNLC).
Basic Life Support certification from the American Heart Association; the posting specifies this as required for the Level 3 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 with care management responsibilities.
Ability to serve as a liaison between patients, families, and healthcare providers.
Proficiency with electronic health records 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 care 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 ensure 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, identify coding and documentation opportunities, monitor performance metrics, and support compliance with risk adjustment guidelines.
Perform other duties as assigned.