RN Case Manager – Complex Care & Coordination

CommunityCare HMO, Inc.; Tulsa (OK); On-site; USD 70,000 - 95,000; Full time

Job summary

CommunityCare HMO, Inc. in Tulsa, OK seeks a Medical Management - Case Management Specialist RN to coordinate care for members with complex needs. You will collaborate with providers and multidisciplinary teams to optimize outcomes while ensuring cost-effective options.

The role requires an Oklahoma RN license, 3+ years of clinical nursing experience, and strong documentation skills. CCM certification is preferred, and adherence to CMS/URAC standards will be part of daily duties.

Qualifications

• Licensed RN in Oklahoma.
• 3+ years of clinical nursing experience.
• CCM certification preferred.

Responsibilities

• Perform clinical assessments for case management to facilitate authorizations.
• Collaborate with PCP offices to address medical needs and barriers.
• Conduct reviews to engage members and set health goals.
• Carry out telephonic or face-to-face case reviews with Medical Director as needed.
• Monitor benefits and health status to identify cost-effective care options.

Skills

Assessment

Clinical reasoning

Communication skills

MS Office proficiency

Managed care knowledge

Education

RN license

Nursing degree

CCM certification (preferred)

Tools

Microsoft Office

Job description

CommunityCare HMO, Inc. in Tulsa, OK seeks a Medical Management - Case Management Specialist RN to coordinate care for members with complex needs. You will collaborate with providers and multidisciplinary teams to optimize outcomes while ensuring cost-effective options.

The role requires an Oklahoma RN license, 3+ years of clinical nursing experience, and strong documentation skills. CCM certification is preferred, and adherence to CMS/URAC standards will be part of daily duties.