Complex Care Manager, LCSW - Emergency Dept (Days)

MECO Care Saalekreis GmbH; Oklahoma City (OK); Sur place; USD 75 000 - 105 000; Plein temps

Avantages offerts par ce poste

PTO

401(k)

Medical & Dental

Résumé du poste

OU Health seeks a Complex Care Manager (LCSW) for the Emergency Department in downtown Oklahoma City. The role focuses on engaging frequent healthcare utilizers, closing gaps in care, and ensuring sustainable support systems.

Strong clinical judgment, care coordination, and patient-centered care are essential. The position involves EMR reviews, readmission analysis, complex discharge planning, and collaboration with physicians and payers to optimize care and reduce avoidable hospitalizations.

Qualifications

• Education: BSN for nurses or MSW for social workers.
• Licensure: LMSW or LCSW required (supervision as applicable).
• 5+ years in care management, 1 in acute/ambulatory setting.
• BLS certification required.

Responsabilités

• Perform EMR reviews and patient interviews to close care gaps.
• Lead readmission reviews and implement reduction strategies.
• Manage denial cases and advocate for coverage.
• Coordinate complex discharge planning and transitions of care.
• Analyze utilization data and performance metrics.

Connaissances

Care coordination

LCSW

EMR reviews

Discharge planning

Communication skills

CMS knowledge

Formation

MSW

LCSW licensure

Outils

EHR systems

Care management software

Description du poste

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

• 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.

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. OU Health is the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Health is home to Oklahoma’s largest doctor network with a complete range of specialty care. OU Health serves Oklahoma and the region with the state’s only freestanding children’s hospital, the only National Cancer Institute-Designated OU Health Stephenson Cancer Center, Oklahoma’s flagship hospital, which serves as the state’s only Level 1 trauma center and Edmond Medical Center in the heart of the Edmond Community. Becker’s Hospital Review named University of Oklahoma Medical Center one of the 100 Great Hospitals in America for 2020. OU Health’s oncology program at OU Health Stephenson Cancer Center was named Oklahoma’s top facility for cancer care by U.S. News & World Report in its 2020-21 rankings. OU Health also was ranked by U.S. News & World Report as high performing in these specialties: Colon Surgery, COPD and Congestive Heart Failure. OU Health’s mission is to lead healthcare in patient care, education and research. Experts in prevention, treatment and cures, our team works to improve lives through innovation in medical care, education and research, while investing in the people, technologies and facilities that will enable us to achieve our goals.

We are seeking individuals who have a passion and talent for caring for others. By joining our team, you will provide quality health care to our community through the work you do every day. We provide clinical and non-clinical opportunities to further your career and we invite you to explore our available positions.

Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity, genetic information or protected veteran status in accordance with applicable federal laws. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves of absence, compensation, and training. Reasonable accommodations are made to the known physical and mental limitations of qualified individuals with disabilities.