Case Manager RN (52895)

Paycom - ATS; Oklahoma City (OK); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote work

Job summary

GlobalHealth seeks an experienced RN Case Manager to manage care for Medicare Advantage members, coordinating with providers and care teams. The role emphasizes advocacy, education, and post-discharge support in a remote setting.

The ideal candidate has active Oklahoma RN licensure, strong communication skills, and familiarity with disease management and community resources. Remote work is supported with HIPAA-compliant practices.

Qualifications

• Active RN license in Oklahoma required
• Experience in managed care/utilization management preferred
• Knowledge of nursing processes, medications, and community resources

Responsibilities

• Conducts telephonic case management for high-risk members and coordinates care
• Coordinates with providers to ensure holistic outcomes
• Educates members and caregivers on conditions and self-management techniques
• Initiates and participates in SNP MOC elements (HRA, ICP, ICT)
• Performs post-discharge activities including TOC and medication reconciliation

Skills

Nursing processes

Care coordination

Communication

Time management

Case management

MS Office

Education

Registered Nurse license (OK )

Multistate RN license preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Job Details:

Job Location: Any Location Remote US - Oklahoma City, OK 73102, Position Type: Full Time, Education Level: High School or Equivalent, Travel Percentage: None, Job Shift: Day, Job Category: Nurse,

WHO WE ARE:

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE:

This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.

ESSENTIAL JOB FUNCTIONS:

• Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the department's policies and procedures.
• Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes.
• Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges.
• Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention.
• Coordination of services for members, including community resources and collaboration with other members of the care team.
• Educate members and their caregivers on conditions and self-management techniques.
• Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT.
• Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.

Qualifications: EDUCATION AND EXPERIENCE:

• Active Registered Nurse license in the state of Oklahoma required
• Active multi-state RN license is preferred
• Previous experience in managed care/utilization management preferred

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
• Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
• Must be able to communicate, both orally and in writing, clearly and effectively
• Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.

WORK ENVIRONMENT:

Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

TRAVEL:

N/A

SUPERVISORY RESPONSIBILITY:

N/A

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.