Complex Care Manager, RN - Emergency Dept (Days)

OU Medicine; United States; On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Possible relocation assistance

PTO

401(k)

Job summary

OU Health is seeking a Complex Care Manager, RN for the Emergency Department in Downtown Oklahoma City. The role focuses on engaging high-utilizers, closing care gaps, and coordinating services to support patients with complex needs.

Ideal candidates will have strong clinical judgment, care coordination expertise, and experience with care management, CMS guidelines, and EHR systems. A BSN (or LMSW/LCSW with RN) and BLS are required to ensure safe transitions and patient-centered care.

Qualifications

• RN with BSN required or LMSW/LCSW under supervision for RN role.
• At least 5 years in care management, 1 in acute/ambulatory care.
• BLS certification required.

Responsibilities

• Conducts EMR reviews and patient interviews to identify care gaps.
• Performs readmission reviews and reduces avoidable hospitalizations.
• Facilitates complex discharge planning and care transitions.
• Collaborates with physicians and payers to review medical necessity and coordinate coverage.
• Mentors students and represents the department on hospital committees.

Skills

Clinical judgment

Care coordination

Patient-centered care

Verbal & written communication

EHR proficiency

Education

BSN (RN)

LMSW/LCSW

Tools

EMR reviews

Care management software

EHR systems

Job description

Position Title: Complex Care Manager, RN - Emergency Dept (Days)

Department: OUMC ED Care Management

Job Description:

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

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.
• 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.
• 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

• 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.

Benefits

• Possible relocation assistance if you are located outside of 100 miles!
• We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more.

OU Health is an equal opportunity employer.

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

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.