Case Manager RN - Pediatric Complex Care

OU Health; Oklahoma City (OK); Vor Ort; USD 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

PTO

401(k)

Medical plan

Dental plan

Zusammenfassung

OU Health seeks a Complex Care Manager to coordinate care for patients with high-risk conditions, focusing on EMR reviews, care transitions, and reducing readmissions. The role emphasizes collaboration with physicians and the interdisciplinary team.

Ideal candidate may be a Registered Nurse (RN) or Social Worker with LMSW/LCSW; requires strong clinical judgment, care coordination expertise, and patient-centered care. Location: Downtown Oklahoma City; Shift: M-F Days.

Qualifikationen

• Minimum 5 years of care management experience, 1 year in acute or ambulatory care.
• RN with Oklahoma RN license or LMSW/LCSW eligible.

Aufgaben

• Conducts EMR reviews and patient interviews to assess and close care gaps.
• Performs readmission reviews and develops strategies to reduce hospitalizations.
• Manages denial cases with physicians and payers to ensure appropriate coverage.
• Facilitates complex discharge planning and safe transitions of care.
• Analyzes utilization metrics and identifies improvement opportunities.
• Collaborates with interdisciplinary team to coordinate services across programs.

Kenntnisse

Verbal communication

Written communication

Detail oriented

Critical thinking

Care coordination

EHR proficiency

Team collaboration

Ausbildung

BSN

LMSW/LCSW

Tools

None

Jobbeschreibung

New to OU Health? Ask your recruiter about our competitive wages and total rewards package, including possible relocation assistance if you are located outside of 100 miles!

This position focuses on engaging frequent healthcare utilizers, addressing gaps in care, and helping patients establish sustainable healthcare support systems. The ideal candidate combines strong clinical judgment, care coordination expertise, and a commitment to patient-centered care.

SHIFT/LOCATION: M-F Days, Downtown Oklahoma City

**Ideal candidate will fulfill this role as a Registered Nurse due to cope of work and the business needs .**

A Complex Care Manager is accountable and responsible for coordinating or evaluating the cases for patients with multiple chronic conditions, high-risk health concerns, readmission, or denial of patient status. You will strive to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. Your primary responsibility will be conducting electronic medical record (EMR) reviews and/or patient interviews-via face-to-face or telephonic engagement-to assess, identify, and close clinical and non-clinical gaps in patient care.

Essential Responsibilities

• Conducts EMR reviews and/or patient interviews via face-to-face and/or telephonic engagements to assess, identify, and address clinical and non-clinical gaps in patient care.
• Performs readmission reviews to evaluate contributing factors and implement strategies to reduce avoidable hospitalizations.
• Manages denial cases, including reviewing medical necessity, collaborating with physicians and payers, and advocating for appropriate patient care coverage.
• Facilitates complex discharge planning, ensuring safe and effective transitions of care for patients requiring specialized placement or services.
• Assists with the collection, analysis, and benchmarking of utilization, process, and outcome metrics to identify trends and areas for improvement.
• Analyzes productivity measures and evaluates the effectiveness of care management strategies in achieving clinical, financial, and patient-centered outcomes.
• Researches, evaluates, and recommends resources to meet medical and non-medical needs of patients and families.
• Utilizes clinical expertise and understanding of care management, Medicare regulations, and contributes to the goals of cost containment and quality care and provides safe and appropriate transitions of care.
• Collaborates, refers, and communicates across all programs to ensure appropriate coordination of services.
• Works collaboratively and maintains active communication with physicians, nursing, and other members of the interdisciplinary team to effect timely and appropriate patient management.
• Serves as an advocate, placing the needs of patients and their families first. Delivering compassionate care that is whole person care: body, mind, and spirit.
• Supports shared decision making and encourages patient adherence to their care plans.
• Promote patient and family responsibility and self-management.
• Conducts EMR reviews and patient interviews via face-to-face and/or telephonic engagements to assess, identify, and close clinical and non-clinical gaps in patient care.
• Evaluate changes in patient-reported symptoms and conduct additional triage and screening to determine next steps.
• Assists with the collection, analysis and benchmarking of utilization, process, and outcomes metrics.
• Analyzes productivity. Measure outcomes and effectiveness of care management including clinical, financial, quality of life and patient/family satisfaction. Identifies opportunities for continuous improvement.
• Participates and promotes performance improvement projects.
• Supervise and mentor students
• Represent the care management department in hospital committees and task forces.

General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications

Education Requirements

• Nurses: Bachelor of Science in Nursing (BSN) required.
• Social Workers: Graduate of an accredited school of social work. License Master Social Worker (LMSW) under supervision or Licensed Clinical Social Work (LCSW) required.

Experience Requirements

• At least 5 years Care Management experience, 1 in an acute or ambulatory care setting.

License/Certification/Registration Requirements

• If applying as a Registered Nurse: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)).
• If applying as a Social Worker: Current Licensed Master Social Worker (LMSW) or under supervision for Licensed Clinical Social Work (LCSW) or LCSW from the Oklahoma State Board of Licensed Social Workers.
• Basic Life Support from the American Heart Association required.

Knowledge/Skills/Abilities Required

• Professional demeanor. Self-directed. Ability to work as a member of a team.
• Excellent verbal and written communication (including documentation) skills.
• Detailed - oriented with excellent organizational skills.
• Commitment to fostering a culture of continuous learning, quality improvement, and patient-centered care.
• Strong assessment, critical thinking, and problem-solving skills
• Strong knowledge of healthcare regulations, including CMS guideline
• Show clear understanding of utilization management principles and integrate these with care management responsibilities.
• Serve as liaison between patients, families, and healthcare providers.
• Excellent organizational and project management abilities.
• Knowledge and skill in chronic disease management
• Strong organizational and time-management
• Ability to assess, adapt, and calmly respond to changing and crisis environment.
• Ability to facilitate patient access to community resources.
• Proficiency in utilizing electronic health records (EHR) and care management software.

OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.