RN Care Manager – HCC Risk Adjustment & Value-Based Care

OU Health Partners; United States; Presencial; USD 70.000 - 95.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

PTO

401(k)

Medical and dental plans

Descripción de la vacante

OU Health is seeking a Registered Nurse Care Manager to lead HCC risk adjustment and coding initiatives across ambulatory settings in downtown Oklahoma City. This role partners with providers, clinical teams, coding specialists, and payors to improve documentation accuracy and support value-based care performance.

The ideal candidate has experience in HCC coding, risk adjustment, and clinical documentation improvement, with strong clinical, analytical, and project leadership skills.

Formación

• Associates degree, or higher, in nursing required.
• Bachelor's degree in nursing preferred (Level 2/3).
• Current RN license (OK) and BLS required.

Responsabilidades

• Conduct comprehensive assessments of patients' health status and care needs.
• Develop individualized care plans with the healthcare team.
• Provide patient and family education on conditions, treatment, and self-care.

Descripción del empleo

Position Title

RN Care Manager – HCC Risk Adjustment & Value-Based Care

Department

Care Management: Ambulatory Clinics

Job Description

OU Health is seeking a Registered Nurse Care Manager to lead HCC risk adjustment and coding initiatives across ambulatory care settings. This role partners with providers, clinical teams, coding specialists, and payors to improve documentation accuracy, optimize risk capture, and support value-based care performance.

Key responsibilities include leading HCC education efforts, identifying coding and documentation opportunities, monitoring performance metrics, and ensuring compliance with risk adjustment guidelines.

This is a clinical leadership and project facilitation role rather than a traditional patient-facing care management position.

The ideal candidate will have experience in HCC coding, risk adjustment, clinical documentation improvement, and value-based care, along with strong clinical, analytical, and project leadership skills.

THIS POSITION IS ONSITE - DOWNTOWN OKC.

Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary responsibility of the role will be to assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet the healthcare needs of patients, while promoting quality outcomes and patient satisfaction.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Conduct comprehensive assessments of patients' health status, medical history, and ongoing care needs.
• Develop individualized care plans in collaboration with the interdisciplinary healthcare team, patients, and their families to ensure continuity of care.
• Provide education to patients and their families regarding their health conditions, treatment plans, medications, financial expectations, and self-care strategies.
• Coordinate and facilitate communication between patients, families, healthcare providers, and community resources to optimize patient care outcomes.
• Evaluate effectiveness of care plans and adjust as necessary.
• Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and cost-effectiveness.
• Advocate for appropriate allocation of resources and services to meet patients' needs while adhering to regulatory guidelines and reimbursement criteria.
• Collaborate with insurance providers, social workers, and other stakeholders to ensure timely authorization of services and coverage for patients.
• Monitor and evaluate patient outcomes, healthcare processes, and care delivery systems to identify areas for improvement.
• Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practices and enhance patient safety and satisfaction.
• Ensure compliance with federal, state, and local regulations, as well as accreditation requirements related to care management and patient care.
• Implement strategies to minimize readmissions, prevent complications, and optimize care planning processes.

General Responsibilities Performs other duties as assigned.

Minimum Qualifications (Level 1)

• Education Requirements: Associate's degree, or higher, in nursing required.
• Experience Requirements : Minimum of 0 - 3 years Nursing experience required, with Care Management experience preferred.
• License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required.

Minimum Qualifications (Level 2)

• Education Requirements: Bachelor's degree in nursing required.
• Experience Requirements: At least 3 years of Care Management experience.
• License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required.

Minimum Qualifications (Level 3)

• Education Requirements: Bachelor's degree in nursing required.
• Experience Requirements: At least 5 years of Care Management experience.
• License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required for inpatient setting.

Knowledge/Skills/Abilities Required

• Demonstrates expertise in regulatory requirements regarding the care management discipline.
• Strong communication, interpersonal, and leadership 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.
• Proficiency in utilizing electronic health records (EHR) and care management software.

Benefits

We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.

About OU Health

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 Opportunity

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.