Population Health Nurse Case Manager — Care Coordination

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

Job summary

CommunityCare HMO Inc. is seeking a Population Health Nurse Case Manager to support Population Health Management by assessing member needs, coordinating care, and improving health outcomes.

The role collaborates with members, caregivers, providers, and interdisciplinary teams to develop individualized care plans, address barriers, and reduce avoidable utilization while ensuring quality standards and regulatory requirements.

Qualifications

• RN license (OK) with current, active status.
• Minimum 4 years of clinical nursing experience in acute care.
• Experience in discharge planning or case management preferred.
• CCM certification preferred.
• Knowledge of managed care and community resources.

Responsibilities

• Identify and engage members with complex conditions or elevated health risks.
• Complete member assessments and develop individualized care plans.
• Provide ongoing outreach to monitor progress and adjust plans.
• Coordinate care across medical, behavioral health, pharmacy, and community services.
• Support transitions of care with timely follow-up and discharge coordination.
• Educate members and caregivers on chronic disease management and adherence.
• Address social barriers to care such as transportation and access.
• Participate in interdisciplinary care meetings and share care plans.
• Maintain timely documentation for quality improvement and accreditation.

Skills

Managed care knowledge

Case management

Clinical judgment

Organizational & communication skills

Microsoft Office proficiency

Education

RN license – Oklahoma

Acute care nursing experience (4+ yrs)

Discharge planning / case management experience

CCM certification preferred

Tools

EHR/EMR systems

Job description

CommunityCare HMO Inc. is seeking a Population Health Nurse Case Manager to support Population Health Management by assessing member needs, coordinating care, and improving health outcomes.

The role collaborates with members, caregivers, providers, and interdisciplinary teams to develop individualized care plans, address barriers, and reduce avoidable utilization while ensuring quality standards and regulatory requirements.