Nurse Care Manager

Oklahoma AG; Oklahoma City (OK); On-site; USD 66,000 - 81,000; Full time

Benefits offered by this job

State-paid benefits

Flexible Spending Accounts

Retirement Savings Plan with employer

11 paid holidays

15 days vacation

15 days sick leave

Longevity bonus

Public Service Loan Forgiveness and tu

Wellness benefits and on-site gym

Job summary

Oklahoma Health Care Authority (OHCA) in Oklahoma City is recruiting a Nurse Care Manager to coordinate access to medical care and community resources for SoonerCare members. You will conduct clinical reviews, facilitate care management activities, and collaborate with agency staff to ensure compliance with state and federal guidelines.

The role requires an RN license in Oklahoma (or eNLC) and at least 2 years of professional nursing experience.

Qualifications

• The Nurse Care Manager must hold a valid RN license in Oklahoma or via eNLC and have at least 2 years of nursing experience.
• Knowledge of clinical case management and community resource coordination is required.
• Preferred qualifications include a higher health degree and familiarity with UCAT, MS Office tools.

Responsibilities

• Coordinate and facilitate access to medical care for medically complex members.
• Facilitate access to community resources and social services within SoonerCare guidelines.
• Conduct clinical reviews and document activities using the case management system.
• Prepare cost-effectiveness statements and documentation as needed.
• Collaborate with intra- and inter-agency staff on policy and program issues.
• Participate in case staffing meetings and assist with adjudication of appeals.

Skills

Clinical case management

Community resource coordination

Effective communication

Problem solving

Policy compliance

Education

RN license (OK/eNLC)

2 years nursing experience

MSN preferred

Tools

UCAT

MS Excel

PowerPoint

MS Access

Job description

Nurse Care Manager Agency

Employer: Oklahoma Health Care Authority (OHCA)

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

Salary: $73,325/year

Full time / Regular

Work Schedule: Monday – Friday; Primary Hours: 8:00 a.m. – 5:00 p.m.

Benefits

• 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.

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

• 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.


• Interface 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.

Qualifications

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 thinking are necessary for navigating complex healthcare systems, ensuring compliance, and advocating for members with special healthcare needs. The Korn Ferry competencies that best align with this role include Ensures Accountability (demonstrating ownership for program adherence and compliance) and Collaborates (working effectively with diverse internal and external stakeholders to provide comprehensive care management).

To be considered for this position your application must include a resume/CV with complete work and education history.

Education and/or Experience: Possession of a valid permanent Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC) AND 2 years of professional nursing experience.

Preferred Qualifications

• Experience as an Exceptional Needs Coordinator, Nurse Case Manager or Quality Assurance/Utilization Review Nurse.


• Advanced Health-related Education (e.g. MSN).


• Experience with the Uniform Comprehensive Assessment Tool (UCAT).


• Experience with aged, blind or disabled population.


• Experience with Medicaid/SoonerCare Related Professional Certifications (other than BLS/ALS/PALS).


• Experience with MS, Excel, Access, PowerPoint.


• Bilingual.

Physical Demands and Work Environment

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.

Accommodation Statement

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

Industries: Government Administration Worker Size: 10,001+ Employees Headquarters: Oklahoma City, Oklahoma