Nurse Care Manager

okgov; Oklahoma; On-site; USD 66,000 - 81,000; Full time

Job summary

The Nurse Care Manager position at Oklahoma Health Care Authority (OHCA) focuses on coordinating medical care, community resources, and social services for SoonerCare members with complex needs. The role includes conducting clinical reviews and supporting case management decisions to ensure compliance with state and federal guidelines.

You will engage with members, families, and providers to resolve issues, participate in QA, and uphold OHCA values while working Monday–Friday in Oklahoma City.

Qualifications

• Experience in care management and coordinating medical care.
• Familiarity with SoonerCare program guidelines.
• Strong communication with members and providers.

Responsibilities

• Coordinate access to medical care for medically complex members.
• Conduct clinical reviews and document care management activities.
• Collaborate with intra- and inter-agency personnel on policy and program issues.
• Interface with members, families, and providers to resolve issues.

Job description

Job Posting Title

Nurse Care Manager

Agency

807 HEALTH CARE AUTHORITY

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date

Continuous if Blank

Full/Part-Time

Full time

Job Type

Regular

Compensation

$73,325/year

Why You'll Love Working Here

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership , we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

Let's Talk Benefits

We know your great work deserves great support. Here's a snapshot of what we offer for all eligible employees.

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $73,325/year

Work Schedule: Monday - Friday

Primary Hours: 8:00 a.m. - 5:00 p.m.

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better hea l th and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Nurse Care Manager ensures that medically complex and special healthcare needs of SoonerCare members are effectively managed by coordinating access to medical care, community resources, and social services. This role involves conducting clinical reviews, facilitating care management activities, and collaborating with intra- and inter-agency personnel to ensure program adherence to state and federal guidelines. Additionally, the Nurse Care Manager supports the agency's mission by providing leadership in resolving member issues, contributing to case management decisions, and advocating for the needs of vulnerable populations while ensuring compliance with OHCA policies and program requirements.

Essential Functions May Include :

• Coordinate and facilitate access to medical care for medically complex/special health care needs members identified through various referral sources including self-referrals, provider referrals, and other state agency referrals. Facilitate access to community resources and social service agencies within the parameters of the SoonerCare program.
• Conduct clinical reviews and document Care Management activities utilizing the clinical case management system and other available tools. Complete level of care determinations and assessments for identified populations using standardized tools and processes. Prepare cost-effectiveness statements, reports, and other necessary documentation.
• Collaborate with intra-agency and inter-agency personnel regarding policy and program issues related to Care Management. Participate in case staffing meetings and collaborate with other agency staff to ensure coordination of efforts. Provide testimony as requested for adjudication of administrative appeals.
• I nterface verbally and in writing with members, families, and providers to resolve issues. Act as a SoonerCare Care Management resource, answering questions for OHCA personnel related to the complex special needs of identified members.
• Work with internal and external QA processes to monitor program adherence to state and federal guidelines and contracts. Represent OHCA SoonerCare in public forums involving various stakeholder groups, informational seminars, and training sessions as assigned.
• Evaluate appropriateness for healthcare services for identified clients and make recommendations for care plans based on established guidelines for the clients diagnosed condition.
• Other duties as assigned.

Knowledge, Skills, Abilities and Competency Requirements

The Nurse Care Manager requires in-depth knowledge of healthcare policies, clinical case management, and community resource coordination, along with the ability to communicate effectively with members, providers, and agencies. Strong problem-solving skills and strategic thinkin