Complex Care Manager, LCSW - Emergency Dept (Days)

OU Health; Oklahoma City (OK); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

PTO

401(k)

Medical and dental plans

Job summary

OU Health's Complex Care Manager, LCSW – Emergency Dept (Days) in Downtown Oklahoma City leads care coordination for high-utilization patients, ensuring safe transitions and effective resource use. The role emphasizes collaboration with physicians and the care team to address gaps in care and promote patient-centered outcomes.

The position requires nursing or social work credentials (BSN or LMSW/LCSW) with licensure, at least 5 years in care management, and strong knowledge of EHR systems and

Qualifications

• Bachelor's degree in nursing or social work; RN/BSN or LMSW/LCSW with supervision is required.
• Minimum 5 years in care management, including acute or ambulatory settings.
• Current Life Support certification per American Heart Association.
• License verification for RN or LMSW/LCSW as applicable.

Responsibilities

• Conducts EMR reviews and patient interviews to identify gaps in care.
• Performs readmission reviews and reduces avoidable hospitalizations.
• Manages denial cases with physicians and payers; advocates for coverage.
• Facilitates complex discharge planning and transitions of care.
• Analyzes utilization metrics and identifies improvement opportunities.
• Collaborates across programs to ensure coordinated services.
• Maintains communication with physicians, nursing, and interdisciplinary teams.
• Promotes patient-centered care and shared decision making.
• Supervise and mentor students and participate in hospital committees.

Skills

Care coordination

Communication

Regulatory knowledge

EHR proficiency

Problem solving

Project management

Team collaboration

Crisis management

Education

BSN

LMSW/LCSW licensed

Tools

EHR systems

Care management software

Job description

Position Title

Complex Care Manager, LCSW - Emergency Dept (Days)

Department

OUMC ED Care Management

Job Description

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

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• 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

• 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 Worker (LCSW) required.

Experience

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

License/Certification/Registration

• 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.

Equal Opportunity Statement

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.