Nurse Case Manager: Population Health & Care Coordination

CommunityCare, Inc.; Tulsa (OK); Hybrid; USD 65,000 - 90,000; Full time

Job summary

CommunityCare, Inc. is seeking a Population Health Nurse Case Manager to enhance PHM by assessing member needs, coordinating care and promoting better health outcomes.

You will work with members, families, providers, and teams to create individualized care plans and reduce avoidable utilization. You will identify high-risk members, complete assessments, and maintain care plans while addressing barriers to care.

Qualifications

• Active Oklahoma RN license and nursing degree.
• Minimum four years of clinical nursing experience in an acute care setting.
• Discharge planning or case management experience preferred.
• CCM certification preferred.

Responsibilities

• Identify and engage members with complex conditions or elevated health risks.
• Complete assessments and develop individualized care plans within nursing scope.
• Provide ongoing outreach to monitor progress and update plans.
• Coordinate medical, behavioral health, pharmacy, and community services.
• Support transitions of care with timely follow-up and discharge coordination.
• Educate members and caregivers on chronic condition management and adherence.
• Address social needs and barriers impacting access and health literacy.
• Participate in interdisciplinary care meetings and share care plans.
• Maintain timely documentation and support quality, accreditation, and regulatory needs.
• Perform other duties as required.

Skills

Managed care

Case management

Chronic conditions

Community resources

Clinical judgment

Organizational skills

Communication skills

Collaboration skills

Prioritization

Microsoft Office

Care management systems

Background check

Education

RN license (Oklahoma)

CCM certification preferred

Tools

Microsoft Office

Electronic care management systems

Job description

CommunityCare, Inc. is seeking a Population Health Nurse Case Manager to enhance PHM by assessing member needs, coordinating care and promoting better health outcomes.

You will work with members, families, providers, and teams to create individualized care plans and reduce avoidable utilization. You will identify high-risk members, complete assessments, and maintain care plans while addressing barriers to care.