RN Case Manager: Coordinated Care & Outcomes

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

Job summary

CommunityCare HMO Inc. is seeking an experienced Registered Nurse for case management to coordinate healthcare for members with complex needs.

You will work with members, providers, and the multidisciplinary team to facilitate appropriate care and cost-effective options. You will complete clinical assessments, collaborate with PCPs, conduct reviews, and document interactions while ensuring CMS and URAC regulatory compliance.

Qualifications

• Ability to assess situation, consider alternatives and choose the appropriate course of action.
• Strong oral and written communication skills.
• Knowledge of managed care and associated group benefit plans.
• Proficient with Microsoft applications.
• Successful completion of Health Care Sanctions background check.

Responsibilities

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

Skills

Assessment & clinical judgment

Communication skills

Microsoft Office

Education

Graduation from an accredited School of Nursing

RN license in Oklahoma

CCM certification preferred

Job description

CommunityCare HMO Inc. is seeking an experienced Registered Nurse for case management to coordinate healthcare for members with complex needs.

You will work with members, providers, and the multidisciplinary team to facilitate appropriate care and cost-effective options. You will complete clinical assessments, collaborate with PCPs, conduct reviews, and document interactions while ensuring CMS and URAC regulatory compliance.