RN Case Management Specialist – Complex Care Coordination

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 70,000 - 90,000; Full time

Job summary

CommunityCare HMO Inc. in Tulsa, OK, is seeking a Registered Nurse Case Manager to coordinate care for members with complex health needs. You will work with members, providers and a multidisciplinary team to optimize outcomes and cost-effective care across the continuum.

The role requires active Oklahoma RN licensure and 3+ years of clinical nursing experience; CCM certification is preferred. You will ensure regulatory compliance and thorough documentation within CMS and URAC standards.

Qualifications

• Experience performing clinical nursing assessments for case management.
• Knowledge of managed care and provider benefit plans.
• Strong oral and written communication skills.

Responsibilities

• Complete clinical assessments to assist with authorizations.
• Collaborate with PCP offices to address medical needs.
• Conduct reviews to set patient health goals.
• Perform telephonic or face-to-face case reviews with Medical Director.
• Monitor benefits and health status for cost-effective care.
• Maintain outreach to meet CMS and URAC requirements.
• Document case interactions with providers and team.
• Compile case management research, logs, and data entry.
• Perform other duties as assigned.

Skills

Assessment & clinical judgment

Strong communication

Managed care knowledge

MS Office proficiency

Education

Nursing degree

Tools

Microsoft Office

Job description

CommunityCare HMO Inc. in Tulsa, OK, is seeking a Registered Nurse Case Manager to coordinate care for members with complex health needs. You will work with members, providers and a multidisciplinary team to optimize outcomes and cost-effective care across the continuum.

The role requires active Oklahoma RN licensure and 3+ years of clinical nursing experience; CCM certification is preferred. You will ensure regulatory compliance and thorough documentation within CMS and URAC standards.